• Oral Presentations • A-001

Lenguaje, ideología y poder: discurso dirigido a maestros en torno al VIH/SIDA María T. Borges-Cancel, Francisca Montalvo-Rosado, Lydia E. Santiago-Andújar, Hiram V. Arroyo-Acevedo, Ramón Rosario-Luna, Arnaldo Torres-Degró. Universidad de Puerto Rico, Recinto de Ciencias Médicas; Universidad Interamericana de Puerto Rico; Universidad de Puerto Rico, Recinto de Río Piedras Background and Objectives: La teoría del discurso combina la investigación en salud pública con la lingüística, la psicología y la sociología. Esto permite entender cómo el discurso comunica unas ideas que son la expresión de un orden social. El propósito de esta investigación fue denunciar el discurso hegemónico dirigido a los maestros del Departamento de Educación de Puerto Rico en torno a la educación en salud sobre el VIH/SIDA, durante el periodo de 1988 a 2010. Las preguntas de investigación indagaban sobre los actores, los estereotipos ideológicos, las metáforas, las formas de exclusión, el control discursivo por parte de los grupos de poder, el control de la acción de los grupos menos poderosos y las consecuencias sociales del discurso. Estas preguntas se formularon a partir de las siguientes bases teóricas: la teoría del discurso según van Dijk (2011), y las teorías de poder, ideología y hegemonía según Althusser (1977), Gramsci (1998) y Young (2004) y la aplicación de lo anterior al aparato educativo según Apple (2008). Methods: Esta investigación revisó una muestra de documentos institucionales sobre VIH/SIDA dirigidos a formar los maestros y estudiantes en este tema. Se procedió a desarrollar un marco temático, codificar los datos, organizar los datos y resumir e interpretar los hallazgos. Results: Se encontró el uso de metáforas de guerra, invasión y contaminación. También la reproducción de estereotipos ideológicos que reproducen opresiones de género, orientación sexual. Conclusion: Se propone reconstruir el discurso presente en estos documentos en términos liberadores y democráticos. A-002

Experiences of discrimination in a sample of LGBTT people in Puerto Rico Ricardo L. Vargas-Molina, Edgardo J. Ortiz-Sánchez, Gerardo G. Jovet-Toledo, Edda I. Santiago-Rodríguez, Carlos E. Rodríguez-Díaz, Isabel C. TrinidadSánchez, Sheilla L. Rodríguez-Madera, Carmen M. Vélez-Vega, José J. Mulinelli-Rodríguez. University of Puerto Rico Medical Sciences Campus; Coaí, Inc. Background & Objectives: Lesbian, gay, bisexual, transsexual and transgender (LGBTT) people are disproportionally affected by health disparities due in part to discrimination based on sexual identity and orientation. The objective of this presentation is to explore the experiences of discrimination as reported by a sample of LGBTT individuals in Puerto Rico (PR). Methods: Data was collected during the 2013 LGBTT Pride PaAbstracts • PRHSJ Vol. 33 No. 1 (Supplement) March, 2014

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rade in San Juan, using a brief self-administered survey that included questions on healthcare priorities and needs, disclosure of sexual orientation, and experience of discrimination. A secondary database analysis was conducted using descriptive and bivariate statistics. Results: In the sample (n=160), experiences of discrimination was commonly reported. This was consistent across age group, area of residence and sexual orientation/identity as no statistical differences were found. Across the sample, discrimination due to sexual orientation/identity was more frequently reported in school settings (49.7%). At least a quarter of the sample reported regular or bad experiences based on their sexual orientation/identity when receiving services in governmental offices and when looking for support from relatives. Conclusion: Findings suggest that the experience of discrimination is consistent across age groups, area of residence, and sexual orientation. Therefore, policies and interventions to protect LGBTT individuals in different settings are necessary. Future research should address the feasibility of developing interventions to reduce the experience of discrimination in this group, including training to service providers and to establish and strengthen support networks for LGBTT people in PR. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): We extend our gratitude to the participants, the volunteers who collaborated in data collection, and to Coaí, Inc. for their support to the study. A-003

More than HIV: Healthcare Priorities and Needs from a Sample of LGBTT People in Puerto Rico Carlos E. Rodríguez-Díaz, Edgardo J. Ortiz-Sánchez, Gerardo G. Jovet-Toledo, Edda I. SantiagoRodríguez, Ricardo L. Vargas-Molina, Sheilla L. Rodríguez-Madera, Carmen M. Vélez-Vega, José J. Mulinelli-Rodríguez. Universtiy of Puerto Rico Medical Sciences Campus; Coaí, Inc. Background and Objectives: Lesbian, gay, bisexual, transsexual and transgender (LGBTT) people are disproportionally affected by health disparities. HIV/AIDS has been consistently reported as an important issue in these groups, yet there is a lack of scientific data about their healthcare priorities and needs. The objective of this presentation is to describe healthcare needs and priorities as reported by a sample of LGBTT individuals in Puerto Rico. Methods: Data was collected during the 2013 LGBTT Pride Parade in San Juan, using a brief self-administered survey that included questions on healthcare priorities and needs, disclosure of sexual orientation, and experience of discrimination. A secondary database analysis was conducted using descriptive and bivariate statistics. Results: Among LGBTT participants (n=160) HIV/AIDS (81.3%), mental health (79.4%) and sexual health (71.3%) were identified as leading healthcare priorities. Chi-square analyses were performed using age groups organized by human generations (Baby boomers, X, and Y generations). A statistically significant difference was found for mental health (17-32years=72.4%; 3348years=82.7%; 49+years=100.0%; p-value=0.018). Although 3

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aging as health issue wasn’t reported as a top priority across groups, the bivariate analysis showed a statistically significant difference when stratified by age group (17-32years=25.3%; 33-48years=55.8%; 49+years=75.0%; p-value 9mm). Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): This research was supported by the Departments of Chemistry and Biology of the University of Puerto Rico at Humacao and Dr. Francisco A. Fuentes’ Microbiology Laboratory. A-111

Emergency Department bedside ultrasound aid in the diagnosis of a patient with hypotension Juan M. Garza, María Ramos-Fernández, Manuel Colón. University of Puerto Rico Medical Sciences Campus Background & Objectives: Emergency ultrasound is an imaging modality with a range of benefits in emergency medicine. It is rapid, safe, noninvasive and requires no contrast media or any special patient preparation. Benefits include earlier identification of life-threatening conditions and faster patient care. Emergency ultrasound can be used as an extension of the clinical examination to rule in or rule out key diagnosis in specific clinical settings. We present the case of a 55y/o male with history of HTN, DM who comes to ED with malaise and hypotension. Past medical history pertinent for gradual development of poor appetite and shortness of breath. Physical Exam was pertinent for hypotension, diastolic murmur, and mild rales. Methods: A bedside Tran thoracic ultrasound was done by the Emergency Physician and revealed a large atrial myxoma. Results: Bedside ultrasound finding was confirmed by an echocardiogram and Cardiology Consult. Patient was admitted and follow up with surgeon was arranged for definitive care. Conclusion: Atrial myxomas are found in approximately 14-20% of the population and can lead to embolization, intracardiac obstructions, conduction disturbances and lethal valve obstructions. Although quite rare, left atrial myxomas account for 80% of all cardiac tumors. Diagnosis is often difficult due to the wide array of presenting symptoms. This patient didn't present with the common symptoms associated with an atrial myxoma, which may include chest pain, dyspnea, orthopnea, peripheral embolism or syncope. Emergency bedside ultrasound provided substantial advantages in detecting intracardiac tumor and early diagnosis helped prevent complications. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): No identifiers will be

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used in the case presentation. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. No conflict of interest were identified. A-112

Mantle Cell Lymphoma Mimicking B-cell Prolymphocytic Leukemia Raisa I. Balbuena-Merle, Román Vélez-Rosario, Valmari Ramos, Edgardo Ortiz, José Ortega, Adisbeth Morales. University of Puerto Rico Medical Sciences Campus Background & Objectives: Mantle cell lymphoma (MCL) is a non-Hodgkin B- cell lymphoma that commonly presents with generalized lymphadenopathy, hepatosplenomegaly, and occasional leukemic phase. Usual mantle cell lymphoma cells are small to medium size with inconspicuous nucleoli, but a pleomorphic blastoid variant may resemble prolymphocytes with prominent nucleoli. Methods: We report a case of a 50 year old male presenting with progressive weakness, fatigue, marked leukocytosis, and a cutaneous lesion. Results: The bone marrow biopsy, bone marrow aspirate and peripheral smear (over 1 million white blood cells) were morphologically consistent with Prolymphocytic leukemia, however, immunohistochemistry studies done on the skin biopsy were consistent with MCL. The patient showed rapid deterioration with death occurring four months after the diagnosis. Conclusion: Although exceedingly rare, this aberrant morphological presentation of MCL must be recognized so the patient can receive adequate treatment. A-113

Lymphoproliferative Disorders Associated with Mycophenolate Therapy: Report of Two Cases Liurka V. López-Matías, Román Vélez, Marta Sánchez. University of Puerto Rico Medical Sciences Campus; University of Puerto, Pediatric University Hospital Background & Objectives: Report two cases of lymphoproliferative disorders associated with the use of mycophenolate drug therapy. Case Description: The first case is a 14 year old boy with Down syndrome and nephrotic syndrome treated for one year with mycophenolate who was found with multiple lung nodules as an incidental finding. The second case is that of a 54 year old male that ten years after a heart transplant developed persistent fever and pancytopenia. His maintenance therapy consisted of cyclosporine, mycophenolate and prednisone. Methods: Microscopic and immunohistochemical evaluation was performed in both cases. For the second case a full autopsy was also executed. Results: Lung biopsy, for the first case, revealed a classical Hodgkin Lymphoma-like process. The other case was found with a Post-transplant lymphoproliferative disorder consistent with Diffuse large B cell lymphoma. Conclusion: Mycophenolate is a well known antimetabolite used for immunosuppression after organ transplants and to treat certain autoimmune diseases. It inhibits the enzyme inosine mono-

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phosphate dehydrogenase used in the DNA synthesis and proliferation of B and T lymphocytes. Patients that are treated with this drug are at risk to develop iatrogenic immunodeficiencyassociated Iymphoproliferative disorders or post-transplant lymphoproliferative disorders. For the most part, patients can be asymptomatic or have non-specific symptoms that require a higher level of suspicion to reach a definitive diagnosis. A-114

Concurrent Small Lymphocytic Lymphoma and Classical Hodgkin Lymphoma, Case Report William A. González-Marqués, Alexandra Jiménez, Román Vélez-Rosario, Lili Geng-Zhuang, Adalberto Mendoza-Vallejo, Rafael CaballeroTorres. University of Puerto Rico Medical Sciences Campus; Southern Anatomic, Clinical & Molecular Pathology, Ponce, Puerto Rico; ENT surgery, Santa Rosa Hospital, Guayama, Puerto Rico Background & Objectives: Concurrent lymphomas are rare and are increasingly being reported due to advances in immunohistochemical methods. The simultaneous occurrence of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma in a single lymph node is extremely rare. Mechanisms described for this occurrence include clonal selection, genomic instability, immunosupression, and congenital predisposition. Methods: We present a case of a 43 year-old female who presented with multiple nodules on her lower neck and her left sub-clavicular area. Results: Pathologic evaluation showed partial lymph node involvement with Hodgkin and Reed Sternberg cells with morphologic and immunohistochemical features that corresponded to classical Hodgkin lymphoma, nodular sclerosis subtype. Another portion of the same lymph node and part of the background lymphocytes of the HL showed a lymphocytic infiltrate with morphology and immunophenotype consistent with small lymphocytic lymphoma which was confirmed by flow cytometry. Conclusion: Pathologic evaluation showed partial lymph node involvement with Hodgkin and Reed Sternberg cells with morphologic and immunohistochemical features that corresponded to classical Hodgkin lymphoma, nodular sclerosis subtype. Another portion of the same lymph node and part of the background lymphocytes of the HL showed a lymphocytic infiltrate with morphology and immunophenotype consistent with small lymphocytic lymphoma which was confirmed by flow cytometry. A-115

Epithelioid Hemangioendothelioma: an Unusual Presentation Melissa Sepúlveda-Ramos, Román Vélez-Rosario, Federico Salcedo-Irizarry. University of Puerto Rico Medical Sciences Campus Background & Objectives: Epithelioid hemangioendothelioma represents a borderline or intermediate grade malignant vascular tumor in a spectrum of vascular proliferations between the hemangioma and conventional angiosarcoma. This angiocentric vascular neoplasm has metastatic potential, and is compo-

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sed of epithelioid endothelial cells arranged in short cords and nests placed in a distinctive myxohyaline stroma. The epithelioid hemangioendothelioma was first described by Weiss and Enzinger in 1982. The neoplasm may occur at any age but it is rare during childhood and affects both sexes equally. Nearly one half to two-thirds of cases originate from a vessel, usually a small vein and rarely from a large vein or artery. It usually appears as a solitary, slightly painful soft tissue tumor. The lesion can affect superficial or deep (60%of cases) soft tissue, although similar lesions have exceptionally been reported in the skin and oral cavity. The most common site of occurrence are the extremities (two-thirds of cases), followed by the head and neck region (10-15%), trunk and mediastinum (15%), and other sites. Objective: To describe the rare occurrence of an epithelioid hemangioendothelioma presenting as a periorbital skin lesion in a 26 year old male. A nevus was clinically and histologically suspected. It was a vaguely nested cutaneous epithelioid neoplasm, with no distinctive vasoformation, moderate atypia and mitotic activity, extending into the facial skeletal muscle. Methods: Case report and review of literature Results: Epithelioid hemangioendothelioma is a tumor that has malignant potential and it's prognosis depends on the histologic features. Cases of epithelioid hemangioendothelioma confined to the skin are rare. After complete surgical excision the prognosis of isolated cutaneous cases seems good compared with deep soft tissue cases. Conclusion: Knowledge and a high degree of suspicion are required to diagnose such neoplasm in an unusual location, as seen in this case. A-116

Use of Dexmedetomidine, Ketamine and Propofol During Brainstem Cavernoma Surgery with SSEP and MEP Alberto J. Rivera, Yasmin Maisonave, Myrna Morales. University of Puerto Rico Medical Sciences Campus Background & Objectives: To describe the case of a 45 y/o male patient with incidental finding of Brainstem Cavernoma using Somatosensory (SSEP) and Motor-Evoked (MEP) potential monitoring. Methods: Premedication done with Midazolam, titrated up to 5 mg, and Glycopyrrolate (0.4 mg). IV induction was done with Lidocaine (100 mg), Fentanyl and Propofol titrated up to 100 mcg and 200 mg, respectively, and Succinylcholine (100 mg), in view that ICP was not increased. Following induction of anesthesia, 20-gauge radial arterial line and triple lumen central line were taken. Surgical procedure was maintained with Sevoflurane at 0.5 MAC. Intravenous anesthesia with Dexmedetomidine, 0.9 μg/kg/hour, Ketamine 5 μg/kg/min, and Propofol 100 μg/kg/min, was started. The neurologic monitoring technician applied all necessary equipment for SSEP and MEP monitoring. Results: Intraoperative SSEP and MEP monitoring remained satisfactory throughout the case. Patient remained intubated as a precaution for brainstem edema due surgical manipulation. On postoperative

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day #1, patient was extubated without complications, though found with residual dysphagia. On POD #4, the dysphagia had greatly improved, with no new neurological deficits. Conclusion: Combined SSEP and MEP intraoperative monitoring is frequently used to monitor for intraoperative stimulation. Considering that most anesthetics affect SSEP and MEP, management of these cases can present a challenge. Few studies have taken into consideration the use of Ketamine in the setting of CNS tumor. In this case successful intraoperative neurologic monitoring was performed using Dexmedetomidine, Ketamine and Propofol infusions plus Sevoflurane. When these drugs are used together, sympathetic effects of drugs are offset, thereby providing optimal surgical conditions. A-117

Case of Synchronous Metastatic Breast Carcinoma and Primary Adenocarcinoma of the Endometrium Julio A. Peguero, Annie Vaillant, Luis Santos-Reyes, María Marcos-Martínez. University of Puerto Rico Medical Sciences Campus, San Juan City Hospital Background & Objectives: We report the case of a 63 year old patient with metastatic breast carcinoma to the cervix, fallopian tubes, ovaries, omentum and paraaortic and pelvic lymph nodes, discovered when a total hysterectomy with bilateral salpingoopherectomy was performed to treat an endometrial adenocarcinoma. In this report we illustrate the utility of an appropriate immunohistochemical (IHC) study panel including Mammaglobin, and Gross Cystic Disease Fluid Protein 15(GCDFP-15) in differentiating the primary endometrial adenocarcinoma from breast cancer metastasis in addition to H&E histological examination. Breast cancer metastasis to the uterus and adnexa are relatively uncommon and there is only one previous report of breast cancer metastasis to the uterus co-existing with endometrial adenocarcinoma known to us, and in that case the patient had history of Tamoxifen therapy. Methods: These diagnoses were established by histologic and imunohistochemical pathologic analysis of the specimens obtained after total hysterectomy. A literature review using PubMed searches including the terms “Endometrial Adenocarcinoma AND Metastatic breast cancer” was conducted. Results: Histological features of metastasis can include stromal infiltration without involving endometrial glands, lymphovascular invasion, myometrial invasion and the presence of signet ring cells. Positive IHC in GCDFP-15 and Mammaglobin was identified in signet ring cells in the uterus while endometrial adenocarcinoma cells were negative for these markers. Conclusion: The use of immunohistochemical markers on patients with a history of breast carcinoma can help confirm breast cancer metastasis in the setting of primary endometrial adenocarcinoma. A-118

Isolated Acute Abducens-Nerve Palsy Induced by Vincristine Neurotoxicity in a Pediatric Patient Franchesca García, Wilfredo De Jesús-Rojas, Gloria Colón, Malen Echevarria. University of Puerto Rico Medical Sciences Campus

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Background & Objectives: Vincristine is a neoplastic agent that is part of the treatment of common pediatric malignancies including leukemia. The most common side effect of vincristine is peripheral bilateral neurotoxicity, including abducens nerve neuropathy. We describe a 13-year-old girl with acute lymphoblastic leukemia that developed isolated unilateral abducens nerve palsy after vincristine chemotherapy. Methods: After three weeks of vincristine infusion patient presented to the pediatric emergency room with progressive blurry vision and mild visual loss on the left eye. Results: On initial evaluation patient shows left eye decreased ability to abduct on left lateral gaze. Brain imaging shows no intracranial pathology or lesions. Vincristine-induced neuropathy was considered as suggested by patient history and physical examination. Conclusion: This case report presents an uncommon vincristine side effect in the oncologic pediatric population that is of critical importance to take in consideration. Although literature describes polyneuropathies associated with vincristine, limited cases describing isolated acute abducens cranial nerve palsy in the pediatric population are documented. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): No funding sources or conflict of interest. A-119

A Very Rare Cause of a Life–threatening Metabolic Disorder: Fanconi’s Syndrome and Lactic Acidosis Emmanuel O. González, Marielly Sierra, Tania Zayas, Rodolfo Estremera, Thyra Gutierrez, José Vélez, Mario Mendoza, Héctor Cordova. VA Caribbean Healthcare System; Universidad Central del Caribe, Bayamón, Puerto Rico Background & Objectives: 66 year old man with past medical history chronic Hepatitis C and HIV/AIDS, on a combination of Emtricitabine/Tenofovir presents muscle weakness and polyuria for one week. Physical examination was remarkable for a chronically ill patient without motor focal deficits. He was found with worsening of renal function and was admitted to the hospital with the diagnostic impression of Acute Kidney Injury of unclear etiology. Methods: Laboratories revealed elevated serum creatinine(2.64mg/dl), mixed non-anion gap and high-anion gap metabolic acidosis, hypokalemia(1.68mEq/l), hypophosphatemia(1.0 mg/dl), glycosuria, elevated lactic acid(3.6mmole/L), and positive urine anion gap. Electrolytes replacement was provided and symptoms improved. Tenofovir was discontinued and a rapid improvement in renal function, serum electrolytes and lactic acid levels was observed. Results: Tenofovir may cause severe renal tubular damage leading to the development of Fanconi’s Syndrome. Rarely, in the liver, mitochondrial toxicity causes steatosis and a decrease in lactate clearance leading to lactic acidosis. Conclusion: Tenofovir was the causative agent of the patient’s clinical presentation. Detailed review of the potential side effects of the patient medications prompted us to discover the etiology of the severe metabolic disorder. Rapid discontinuation of Tenofovir was crucial for the patient recovery. To our knowledge, there have been few

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previous reports of Fanconi syndrome and lactic acidosis in HIV-infected patients receiving Tenofovir, almost all lethal. However, in those cases, another drug with lactic acidosis as a side effect was co-prescribed. We describe a case with Tenofovir as the only causative agent of this metabolic disorder. A-120

A life threatening cause of thrombocytopenia Marielly Sierra, Emmanuel O. González, Thyra Gutierrez, Marilyn Medina. VA Caribbean Healthcare System, San Juan, Puerto Rico Background & Objectives: 68 years old male patient admitted to the hospital with the diagnostic impression of syncope after evaluation at Emergency department. Physical examination was unremarkable and patient was admitted for cardiac monitoring. Methods: Laboratory reports pre renal azotemia, hyperkalemia and thrombocytopenia of unclear etiology. Next day laboratories reports a decreasing trend of platelets levels and patient complains of leg pain. At physical exam a new onset bilateral lower extremity pitting edema was noted. Upon reviewing the chart he was recently hospitalized and was treated with subcutaneous heparin for deep venous thrombosis(DVT) prophylaxis. Heparin induced thrombocytopenia was suspected despite not being treated with heparin. Results: Venous Doppler ultrasound reports bilateral popliteal deep vein thrombosis. Patient with a Heparin Induced thrombocytopenia score of 7(highprobability). He was started on Argatroban and transferred to the Intensive care unit. Subsequently, Heparin-induced antibodies results positive. After 6 days of therapy, patient platelets increase to baseline levels and warfarin was started. Conclusion: Heparin Induced Thrombocytopenia is a well described complication of heparin. Heparin is one of the most common forms of inpatient DVT prevention. This case report highlights the importance of a well documented history and physical exam. Careful history of patient recent medications use, prompt us to discover the etiology of clinical presentation and was crucial to avoid detrimental complications. This should be considered as a plausible diagnosis in the setting of a patient who presents with thrombocytopenia and signs of a pro-thrombotic state, with history of a recent admission despite not being currently treated with heparin products. A-121

Inflammatory Myofibroblastic Tumor (Inflammatory Pseudotumor) in the Broad Ligament of a Multiparous Woman Juan J. Mercado, Román Vélez-Rosario. University of Puerto Rico Medical Sciences Campus Background & Objectives: To report the case of a 28 year female G5P2A2 with a broad ligament mass. Methods: Macroscopic, microscopic and immunohistochemical evaluation was performed. Results: Broad ligament biopsy results were diagnosed as an ALK positive inflammatory myofibroblastic tumor. Conclusion: Inflammatory myofibroblastic tumors (IMTs), previously classified as inflammatory pseudotumors, are now known to be a distinct entity. IMT is a rare lesion composed of

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myofibroblastic spindle cells accompanied by an inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils which occur primarily in the soft tissue and viscera. They may arise in any anatomical site including lung, soft tissue, retroperitoneum, abdominal cavity, extremities and bladder, making them an important diagnosis and a challenge to treat since they can occur in proximity to a vital structure and present a variable natural history and biologic behavior, ranging from completely benign, to malignant with a fatal outcome. We present the case of an uterine broad ligament IMT. The cases of IMT reported in the literature involving gynecologic organs are confined to the uterus. To our knowledge, this is the first report of IMT in the broad ligament. A-122

A rare case of an adult with leptomeningeal metastasis and subdural hygromas as initial presentation Carlos R. Berrios, David Blas. University of Puerto Rico Medical Sciences Campus Background & Objectives: Our objective is to present the case of a 81 year old male patient with the finding of leptomeningeal metastasis (LM) an subdural hygromas as initial presentation of lung adenocarcinoma. Methods: This is the case of a 81year-old male who presented with 4-week evolution of loss of balance, inability to stand and speech changes. Physical exam remarkable for scanning speech, truncal ataxia, dysmetria, dysdiadochokinesia, nystagmus, positive Romberg and ataxic gait. Results: Head CT Scan done showed cerebellar edema and bilateral subdural hygromas. Further work up included Brain MRI with gadolinium showed leptomeningeal enhancement mostly in the cerebellum bilaterally and 2 additional enhancing lesions in the right frontal lobe and left basal ganglia. Lumbar puncture showed malignant cells of epithelial origin. Given these findings chest CT and positron emission tomography–computed tomography (PET-CT) were performed to find primary tumor. Chest CT revealed right mid lung mass and PET-CT confirmed the hyper metabolic area. Lung needle biopsy was performed to confirm lung adenocarcinoma. Conclusion: This case is a rare presentation, as only 4% to 15% of patients with solid tumors are diagnosed with leptomeningeal metastasis; of these more than 70% of solid tumors are known to have widely disseminated and metastatic disease at the time of diagnosis of LM. Also, this dual initial presentation of subdural hygromas and leptomeningeal metastasis secondary to lung adenocarcinoma has been reported in fewer than 60 cases and to our knowledge, the first reported in Puerto Rico. A-123

Splenic abscess by Salmonella in an Immunocompetent Pediatric Patient: a case report Manuel Iglesias, Cristel C. Chapel-Crespo. University of Puerto Rico Medical Sciences Campus Background & Objectives: Splenic abscess as a presentation of Salmonella infection is very rare and the majority of reported cases have been associated to immunosuppressive state. We report

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the case of a 6-year-old female who presented with abdominal pain and distention, diarrhea and high-grade fever. Methods: Patient was found on Abdominal CT Scan with a splenic cystic lesion measuring 15 x 13 cm suggestive of a splenic abscess. Percutaneous drainage was placed and fluid was sent for analysis revealing Salmonella type B infection. She was treated with Piperacillin/Tazobactam for 19 days. Immunologic workup was done and found unremarkable. Results: Percutaneous drainage output progressively declined but did not resolve completely for which she was discharge with follow up at surgery clinics with serial abdominal ultrasounds to evaluate for abscess resolution and further removal of the drainage. Patient also required antibiotic and immunization prophylaxis for encapsulated bacteria as with asplenic patients. Conclusion: Most reported cases of splenic abscesses by Salmonella have been associated to immunosuppressive states such as malignancy, immune deficiencies among others. Some cases have also been associated to superinfection of preexisting splenic lesions such as congenital epidermoid cysts, pseudocyst, lymphatic malformation, hydatid cyst, hematomas, or tumors. Interestingly, our patient had no immunodeficiency, or predisposing factors that can explain her presentation of invasive Salmonella infection. Consequently, this makes the case presented extremely rare and worthy of note. A-124

Proptosis in the Pediatric Age: Report of a series at the University Pediatric Hospital Valerie A. Cruz-Flores, Nilka J. Barrios, Gloria Colón, María Correa, María E. Echevarría, Cesar Cortés. University of Puerto Rico Medical Sciences Campus Background & Objectives: Proptosis in the pediatric age is not uncommon. The most common etiological causes are associated to infections and neoplasia. Methods: We reviewed a series of pediatric age patient referrals for proptosis. A retrospective and interventional study included eight children (up to 12 years) with proptosis treated at the department of pediatric oncology from November 2010 to November 2013. All the children endured a systemic evaluation, imaging studies, biopsy, and treatment. Proptosis was managed by surgery, radiotherapy, and chemotherapy after definitive tissue diagnosis and/or imaging studies. Results: This study included seven patients with unilateral proptosis and one patient with bilateral proptosis (granulocytic sarcoma). Five were primary neoplasms; three were secondary tumors. Tissue and/or imaging studies diagnosis included optic glioma (4) rhabdomyosarcoma (1), neuroblastoma (1), granulocytic sarcoma (1), and multifocal osteosarcoma (1). Management included surgery (tissue biopsy), chemotherapy and/or radiotherapy. Six patients are alive and well [rhabdomyosarcoma (1); optic glioma (4), granulocytic sarcoma (1)]. Two are deceased secondary to disease progression [(neuroblastoma (1), multifocal osteosarcoma (1)]. Conclusions: The etiology of proptosis in pediatric oncology can be diverse and careful clinical diagnosis is significantly improved by special radiological examinations such as CT scan and MRI. The diagnosis can only be correctly determined by fine needle

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aspiration cytology, biopsy and radiographic imaging, essential for the specific treatment. Prognosis for these patients will depend on the etiology and extent of the tumor at the time of diagnosis. A-125

Periadrenal Bronchogenic Cyst Clinically Mimicking a Pheochromocytoma Federico Salcedo, Román Vélez, Keila Rivera. University of Puerto Rico Medical Sciences Campus Background & Objectives: Diagnosis of an adrenal mass is challenging, requiring clinical, biochemical, and radiological evaluation. The primary goal is to distinguish between benign or malignant. The most common incidental tumors of the adrenal gland are adenomas and metastases. The size, function and imaging appearance are useful criteria. A periadrenal bronchogenic cyst (BC) is extremely uncommon, very few cases have been reported. BC are congenital malformations derived from the embryonic foregut and usually develop in the mediastinum and lung. We present the case of a 50 y/o female with history of high blood pressure (HBP) and hypothyroidism that presented with a periadrenal BC mimicking a pheochromocytoma. Methods: Patient’s medical history was revised. MRI showed a stable retroperitoneal left adrenal nodularity measuring 1.6 cm which did not follow the criteria for adenoma. However, laboratories resulted with mild increase plasma epinephrine levels (52 pg/ ml ; Reference = 0 - 34 pg/ml), and the patient was presenting HBP suspicious for a pheochromocytoma. A left retroperitoneal laparoscopic adrenalectomy was performed. Macroscopic and microscopic pathologic evaluation of the specimen was performed. Results: Macroscopic evaluation revealed a 2.0 cm cyst with an intracystic yellow-tan proteinaceous fluid, adjacent to the unremarkable adrenal gland. Microscopic evalualtion revealed a pseudostratified ciliated columnar epithelium lining the cyst wall; the adrenal gland was unremarkable. Immunohistochemical studies resulted positive for pankeratin, p63, TTF-1, and negative for chromogranin and synaptophysin. A diagnosis of periadrenal bronchogenic cyst was given. Conclusion: This case emphasizes the rare occurrence of a periadrenal bronchogenic cyst which presented with symptoms and laboratories mimicking a pheochromocytoma. A-126

Crossing the Borders: The power of Nuclear Medicine Imaging Gary Ehlert, Juan C. Negrón, Ralph J. Martín, Frieda Silva. University of Puerto Rico Medical Sciences Campus Background & Objectives: Penetrating injuries are a major cause of mortality and morbidity in our society. Prompt detection and treatment of the injury is a crucial factor in management. The most common diagnostic tool used in this setting is Computed Tomography (CT); however, nuclear medicine procedures can also provide useful physiologic information. We present a case of traumatic hepato-pleural fistula demonstrated by hepatobiliary imaging. Methods: This is a case of a 24 year old

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male seen at the ER due to a gunshot wound to the chest. A right–sided chest tube was inserted to drain a bloody pleural effusion. CT revealed a liver dome laceration with a right diaphragmatic injury. The patient was taken to surgery and postsurgically developed a near complete atelectasis of the right lung. Eleven days after the trauma, surgical drainage of bilious pleural effusion was subsequently performed. Follow-up CT was unable to demonstrate the pathway of bilious material extravasation. Results: A hepatobiliary scintigraphy revealed the hepato-pleural fistula. Conclusion: Traumatic abdominal injuries to the liver and diaphragm can result in hemothorax, bile leaks, lung entrapment and injuries to major vessels. Identification of traumatic injuries by CT is not always straightforward. Hepatobiliary scintigraphy, a readily available procedure, has demonstrated to be valuable in the documentation of biliary leaks. In the acute setting it can be used as a complementary procedure to other anatomic imaging tools to track elusive bile flow across the diaphragm. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The authors have no conflict of interest to disclose. A-127

Recurrent malignant Triton tumor in a patient with NF-1: a case report and review of literature Mara L. Fernández, Keila Rivera, Román Vélez, Juan Vigo. University of Puerto Rico Medical Sciences Campus Background & Objectives: Malignant tumors arising from peripheral nerves or displaying differentiation along the lines of the various elements of the nerve sheath are collectively referred to as malignant peripheral nerve sheath tumors (MPNSTs). “Malignant Triton tumor” refers to MPNSTs showing rhabdomyosarcomatous differentiation. The unusual name "triton" was first used in reference to observation of supernumerary limbs containing bone and muscle growing the backs of tritons after the implantation of the sciatic nerve into the soft tissues of the back. In 1938 Masson and Martin suggested that the neural elements in the tumor induced differentiation of skeletal muscle. The hallmark of this tumor is the presence of rhabdomyoblasts scattered throughout a stroma indistinguishable from an ordinary MPNST. Methods: We reviewed the patient’s medical record as well as conducted a review of literature. Results: We present the case of a 27 year old female with history of type 1 neurofibromatosis that presented with a mass in the right popliteal nerve. After histologic examination and immunohistochemical studies a diagnosis of malignant Triton tumor was reached. After 3 months, the patient presented with a recurrence of the tumor. Conclusion: Nearly 60% of the patients with malignant Triton tumor have type 1 neurofibromatosis. There are now at least 100 reported cases of this example of mesenchymal differentiation. The prognosis of malignant Triton tumors is poor, with 2 and 5 year survival rates of approximately 33 and 12%, respectively. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The authors have no conflict of interest to disclose.

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Eye Trauma and Trismus: A Tetanus Story Esteban A. Del Pilar-Morales, Zaydalee CardonaRodríguez, Juan C. Almodóvar, Alejandro Figueroa, Jorge Bertrán-Pasarell. University of Puerto Rico Medical Sciences Campus Background & Objectives: Tetanus is a potentially life-threatening infection, diagnosis made clinically, without confirmatory test available. Methods: A 57 year old man struck in the right eye by an unknown material, later noticing pain followed by purulent secretions. Evaluation at this time showed pre-orbital cellulitis and antibiotics at the ER. Inability to open mouth, with significant trismus bilaterally noted. Orbit MRI revealed a 5cm long foreign body coursing through the inferior aspect of the orbital cavity. Promptly taken to the OR, where they removed a piece of wood. Given patient’s presentation of trismus and exposure for 1 month to wooden material, cephalic tetanus suspected; empiric therapy begun with tetanus immune globulin as well as active immunization. Trismus resolved over period of several days. Results: Tetanus is a potentially life-threatening infection, diagnosis made clinically, without confirmatory test available. The most frequent presenting symptoms are trismus and dysphagia, usually followed by generalization of the condition. Although the incubation period is usually short, it has been reported that illness may occur even months after exposure. The recognition of the presenting signs of cephalic tetanus allowed the prompt management of the infection. However, because of the rarity of this condition, the clinicians may be unfamiliar with the clinical presentation, and be unsuspecting of the diagnosis. Patients with tetanus should receive active immunization regardless of past immunization. Conclusion: This case illustrates the importance of maintaining a high degree of suspicion for tetanus in patients with adequate history and physical findings to ensure a prompt diagnosis so further complication may be avoided. A-129

Dengue Virus Type 4 as a Transplacentally Transmitted Antibody Martha M. Rodríguez-Fernández, Inés Cuebas. San Juan City Hospital, San Juan, Puerto Rico Background & Objectives: In 2013, there have been 15,187 suspected cases of Dengue Fever (DF) reported. Pregnant women and infants are considered a vulnerable population for developing severe DF. Dengue Hemorrhagic Fever (DHF) can occur during the first infection of infants who received maternal IgG antibodies. Trasplacental dengue antibodies may protect the infant or enhance the risk of developing DHF due to suboptimal neutralizing antibodies. Infants have a more severe presentation caused by their inherently poor capacity to compensate for vascular leakage. Methods: We report the case of a 3 month-old male without significant past medical history with fever, hypoactivity, anorexia and loose stools 3 days prior to admission. Physical findings were positive for aphthous ulcers, tachycardia and macular rash. Admission laboratories showed elevated C-reactive protein. He was managed with IV hydration due to suspected DF. Results: Subsequent labs showed thrombocytopenia, leukopenia, 48

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hypoalbuminemia and, transaminitis, followed by rapid progression of fulminant Disseminated Intravascular Coagulation. The patient developed hypovolemic shock, refractory to treatment with crystalloids, colloids and inotropics. Despite aggressive resuscitation measures at Pediatric Intensive Care Unit, he expired 4 days after admission. Polymerase chain reaction for Dengue Type 4 infection was found positive postmortem. Conclusion: It is hypothesized that Dengue Type 4 infection developed due to maternal trasplacental antibody virus enhancement. To our knowledge there is no consensus in the literature about the adverse effects of trasplacental dengue antibodies on infants. This should be taken into account considering the upcoming dengue vaccine trials. To date, there have only been 43 confirmed cases of DHF. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The authors have no conflict of interests, no funding resources and no disclosures. A-130

Castleman Disease in an Infant: Case Report and Review of Literature Glorimar Rivera, Román Vélez. University of Puerto Rico Medical Sciences Campus Background & Objectives: Castleman disease (angiofollicular lymphoid hyperplasia) is a rare benign lymphoproliferative disorder with a frequent mediastinal location, but possible in any lymph node or extranodal site. It occurs over a broad age range, but rarely occurs in childhood and even rarer in infants and toddlers. There are only 100 pediatric cases described in the literature. We report a case of Castleman disease diagnosed in a three year old girl in a neck lymph node which was present since the age of three months.Castleman disease presents two variants, hyaline-vascular variant and plasma cell variant. They may be unicentric or multicentric. Our case is a unicentric hyaline-vascular variant. Methods: Online medical journal databases were searched for pediatric patients with Castleman disease. Results: A 3 year old girl presented a progressively growing right laterocervical mass since the age of 3 months. In 2010 and 2012, two magnetic resonance imaging studies revealedanhemangioma like lesion, which was refractory to medical therapy. In 2013, a mass at level III of the neck was resected and a neck dissection of levels II, III and IV was performed. The resulting histopathological diagnosis was Castleman disease of hyaline-vascular variant. Conclusion: Castleman disease has rarely been reported in infants.The cervical location, at whatever age, is far rarer than the mediastinal form. Most causes of cervical lymphadenopathy in children are not significant, but some are life threatening. Castleman disease should be included in the differential diagnosis in persistent childhood lymphadenopathy. A-131

Easily curable, yet potentially lethal infectionStrongyloides stercoralis hyperinfection syndrome Thyra Gutierrez, Alex O. Morales, Emmanuel O. González, Viviana Ortiz, Marilyn Medina, Francisco Del Olmo, Onix Cantres. VA Caribbean Healthcare System, San Juan, Puerto Rico

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Background & Objectives: To describe the case of a 75 year old male patient with past medical history of COPD and pure red blood cell aplasia on steroid therapy presents with a three days history of watery, yellowish diarrhea, and abdominal distention. He was found with hypotension, febrile and tachycardic, abdominal distention and right upper quadrant abdominal pain. Methods: Abdominal CT scan reports ascending colitis. Laboratories reveal leukocytosi(39x10^3), elevated liver enzymes and hyperbilirubinemia. Patient required the use of vasopressor therapy and was admitted to Medical Intensive Care Unit. Broad spectrum antibiotics were empirically initiated. Blood culture at 48 hours was positive for gram negative bacteria, further identified as Escherichia coli. Stool culture returned positive for Strongyloides stercolaris. Patient was successfully treated with Ivermectin for 10 days. Results: We present this case as a Strongyloides stercoralis hyperinfection syndrome with ascending colitis, septic shock, and bacteremia as it has been documented cases where the worms enter the bloodstream from the bowel wall, allowing entry of enteric bacteria. Conclusion: Strongyloides stercoralis hyperinfection syndrome is a severe, but easily curable form of strongyloidiasis that carries a high mortality rate if untreated, especially in immunocompromised population. It’s often misdiagnosed accounting for the majority of detrimental cases. Therefore, patients who are considered to be started on systemic steroidal or immunosuppressive therapy should be screened for strongyloides, mostly if peripheral eosinophilia is present. This is a common, curable, and often unnecessarily deadly infectious process that warrants efforts to increase disease awareness. A-132

Preservation of adnexa using ultrasound-guided aspiration as initial treatment for ovarian torsion Viviana Casas, Alberto de la Vega. University of Puerto Rico Medical Sciences Campus Background & Objectives: Adnexal torsion is a rare gynecological event with an incidence of 2.7%. Many anatomic and physiologic factors predispose a women to experience torsion of the ovary, however the true etiology is not always identified. This uncommon gynecologic emergency takes place when the ovary, fallopian tube or both structures twist around its pedicle causing vascular compromise. Ultrasonographic findings and Doppler flow studies are reported to be helpful in achieving a correct diagnosis. It is crucial to identify torsion early and to manage it accordingly in order to preserve the ovary. If left untreated, adnexal torsion may result in an ischemic nonfunctional ovary. This pathology has traditionally been treated by adnexectomy, however a trend towards minimally invasive treatment has made laparoscopic detorsion the surgical approach of choice. We present an even less invasive method of intervention for symptom relief and adnexal detorsion by transabdominal ultrasound-guided simple cyst aspiration. The purpose of this article is to report a case of ovarian torsion in a perimenarcheal nulligravid 16 year old female that was successfully treated via transabdominal ultrasound-guided cyst

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aspiration. Methods: Case report. Results: After conservative management with transabdominal ultrasound-guided cyst aspiration was performed, resumption of ovarian vascular flow as documented by normal Doppler waveforms was identified. The ovary gradually regained a normal appearance by ultrasound, which clinically correlated with complete resolution of pelvic pain and alleviation of symptoms. On follow up study, the sonographic appearance of the previously torsed adnexa revealed functional follicles with resolution of ovarian congestion and edema. The patient had no complications or recurrence of symptoms. Conclusion: Ultrasound-guided ovarian cyst aspiration for ovarian torsion represents a simple, safe, minimally invasive alternative to conventional surgical intervention in selected cases. Functional ovarian recovery and adnexal preservation is possible by applying this simple technique. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): This work required no sources of funding. The authors have no conflicts of interest to disclose. A-133

Case report of Bilateral Mumps after General Anesthesia Víctor Cardona, Carlos Marrero-Prats. University of Puerto Rico Medical Sciences Campus Background & Objectives: Post-anesthesia mumps is a rarely observed event after GETA. Parotid or submandibular swelling develops during surgery or, more often, a few hours later and usually resolves in a few days. The etiology has not been fully explained, but possible causes include trauma, infection, hypersensitivity reactions, and obstruction of the glandular excretory ducts by position, calculi, or thickened secretion. Most of the time this even does not lead to airway obstruction, and is more common unilaterally than bilaterally. The objective of this case report is to describe a very rare presentation of bilateral mumps after GETA. Methods: This is the case of a 66yr male patient with past medical history of HTN and Prostate CA that presented to the OR for a suprapubic prostatectomy. Procedure was uneventful in the surgical and anesthesia aspects, patient was extubated successfully and taken to PACU. Upon arrival at PACU the patient presented with bilateral swelling at the parotid area. The swelling of parotid gland area extended from the pre-auricular/post-auricular angles up to the area of the mandible. Upon clinical examination edema and redness was seen over the abovementioned area although no subcutaneous emphysema was seen. At the time CXR was ordered and bedside US was performed showing parotid enlargement. At the PACU the patient was examined and full workup was ordered. 24hrs after the surgery the redness and swelling had decreased. 48hrs the redness and swelling had completely disappeared and the patient was discharged without any further complications. Results: The surgery was performed in supine position without any surgical nor anesthesiology complication. The exact etiology of this phenomenon is unknown but it has been associated with increased intra-oral pressure due to cough and straining during anesthesia or e passage of air into the parotid gland

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as well as obstruction of secretions. Conclusion: Anesthesia mumps is a rare clinical entity that needs to be present in the differential diagnosis of acute parotid swelling after GETA or regional anesthesia. It’s unknown what could be done to prevent this event but normovolemia during surgery as well as soft pads should be considered. A-134

An Uncommon Case of Neonatal Hyperglycemia due to Transient Neonatal Diabetes Mellitus in Puerto Rico Neichma S. Fargas-Berrios, Marta Valcarcel, Lourdes García-Fragoso. University of Puerto Rico Medical Sciences Campus; University Pediatrics Hospital, San Juan, Puero Rico Background & Objectives: Neonatal hyperglycemia is a common metabolic disorder found in the neonatal intensive care units. There are several and different etiologies for neonatal hyperglycemia. Neonatal diabetes mellitus (NDM) is a very uncommon cause of hyperglycemia in the newborn, occurring 1 in 400,000 births. There are two subtypes of neonatal diabetes mellitus: Permanent (PNDM) and Transient (TNDM). We describe a term small for gestational age female neonate with transient neonatal diabetes mellitus, who presented poor feeding tolerance and vomiting associated with hyperglycemia (385 mg/dL) glycosuria, and metabolic acidosis (pH 7.266, pCO2 25.6 mm Hg, HCO3 11.8 mmol/L and base excess -12.7 mmol/L) within the first 12 hours of life. Methods: The neonate was treated in the Neonatal Intensive Care Unit of University Pediatric Hospital with intravenous insulin, obtaining a slight control of hyperglycemia. An adequate glycemia was obtained at 5 weeks of life. Results: The molecular studies showed complete loss of maternal methylation at the TND differentially methylated region on chromosome 6q24. The etiology of this neonate’s hyperglycemia was a hypomethylation of the maternal TND locus. Conclusion: The cause of neonatal hyperglycemia must be thoroughly investigated due to its diverse etiologies and treatments. A rare cause as neonatal diabetes mellitus is considered if a neonate presents refractory hyperglycemia. Its prevalence in Puerto Rico is unknown and few cases have been reported. To our knowledge this is the first case reported in Puerto Rico of transient neonatal mellitus due to the uncommon mechanism of maternal hypomethylation of the TDN locus. A-135

Rituximab as treatment for Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A case report Kathya E. Ramos, Brenda Deliz, María García. University of Puerto Rico Medical Sciences Campus Background & Objectives: Rituximab is an anti-CD20 monoclonal antibody that destroys CD-20+ cells (B cells). It is commonly used to treat diseases that are characterized by having too many B cells, overactive B cells, or dysfunctional B cells. There have been few reported cases of Rituximab - responsive Chronic

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Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), however there is still big controversy about its efficacy in such condition. Objective: To report the efficacy of Rituximab therapy in a patient diagnosed with CIDP, poorly responsive to intravenous Immunoglobulins (IVIGs), Prednisone and Azathioprine. Methods: 23 y/o male without history of systemic illnesses who presented with insidiously progressive severe motor involvement of all extremities distally (0/5 of muscle strength in upper extremities and in ankles plantar/dorsiflexion), and moderate to severe proximal motor involvement (0/5 – 2/5 of strength) leaving him wheelchair-bound and dependent in all activities of daily living in 6 months. Bilateral facial weakness and tongue fasciculations were also noted at the time. After a complete workup, he was diagnosed with CIDP and was started in high doses of Prednisone and serial monthly IVIGs. After 6 courses of IVIGs he was started on Imuran, but it was discontinued due to reactive pancytopenia. After 1 year of therapy, only mild improvement was reported after the above treatment with the patient still being unable to walk. He was then started on Rituximab 375mg/m2 IV weekly x 1 month. Results: After 3 weeks of treatment, the patient was able to walk using a walker and bilateral ankle-foot orthotics. After 4 doses, he was able to walk without the walker for the first time in a year and a half. Conclusion: Rituximab seems to be a promising effective treatment for unresponsive CIDP. No adverse effects reported in this patient, also suggesting that this is a fairly safe therapy. A-136

Steroid Responsive Myopathy Presenting as Bent Spine Syndrome: A Case Report Noel J. Vargas-Pérez, Gishalaine Alfonso, Brenda Deliz, Juan L. Pérez-Berenguer, Karina Méndez, Kathya Ramos. University of Puerto Rico Medical Sciences Campus Background & Objectives: To describe the case of an elder male with atypical spinal myopathy presenting as bent spine syndrome. Case Description: A 75 year-old male without systemic illness presenting with severe flexed neck and inability to maintain it in the erected position. Weakness was noted upon awakening one morning. He reported dysphagia and progressive difficulty gait since six prior months. Neurological exam remarkable for kyphosis, severe neck flexors weakness and mild proximal extremities weakness. Methods: Labs include mild increased creatinine kinase. Comprehensive metabolic panel, TSH, myasthenia gravis and Lambert-Eaton antibodies and chest CT were normal. Electrodiagnostic studies disclose a myopathic pattern. Deltoid muscle biopsy showed inflammatory changes, many cells with central and peripheral nuclei. Other genetic tests were ordered. Results: Our patient presents with bent spine syndrome (BSS). Etiologies include psychiatric (camptocormia) or other somatic disorders of musculo-skeletal or neurological disorders. Clinical and EMG/NCS studies support a myopathic origin in our patient. BSS of muscular origin may be classified as primary or caused by many secondary

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disorders. After an extensive work-up he was started on steroids with moderate improvement, supporting our impression of an inflammatory myopathy affecting mainly the paraspinal muscles. No disease progression noted. Conclusion: Bent spine syndrome/dropped head syndrome are poorly recognized conditions. It is frequently confused with kyphosis of normal aging or other degenerative diseases. Its prevalence may be higher than reported. It’s important to identify the most common and treatable conditions causing this syndrome to direct therapies and improve quality of life in these patients. A-137

Incidental Metastatic Thyroid Papillary Microcarcinoma in Non-Routine Cadaveric Organ Donor Autopsy Gruschenka N. Mojica-Sánchez, María MarcosMartínez, Juan Pérez-Berenguer, Raisa Balbuena, Melissa Sepúlveda-Ramos, Federico Salcedo. University of Puerto Rico Medical Sciences Campus Background & Objectives: Autopsy in cadaveric organ donors is not routinely performed. We present a case of a 45 year old male evaluated for sudden loss of consciousness, a Glasgow Coma Scale of 3/15 and a brain CT scan exhibiting a left occitoparietal hyperdensity producing significant mass effect. Given a non-diagnostic intraoperative consult for his brain neoplasm, a non-routine, post-organ donation autopsy was performed. Methods: Following clinical brain death declaration, intraoperative consults were placed for brain neoplasm, liver, and bilateral kidney wedge biopsies. Satisfying transplantation criteria, the liver and both kidneys were harvested, followed by autopsy. Results: Intraoperative consult suggested neoplasia not excluding malignancy, with a differential diagnosis of Meningioma, Meningioblastoma, and Hemangiopericytoma. Final neurological consult revealed a left occipitoparietal Meningioma WHO grade 1 measuring 4.5 x 3.5 x 2.5 cm, with associated cerebral edema, left subfalcine, bilateral uncal and tonsilar herniation, Duret’s and interstitial perivascular hemorrhages, and acute hypoxic changes. Autopsy incidentally revealed two confluent nodules in the lower left thyroid lobe measuring 0.5 cm in aggregate with one 0.4 cm metastatic perithyroidal level 4 anterior neck lymph node, diagnosing Thyroid Papillary Microcarcinoma Stage 3, T1N1a. Conclusion: The literature suggests that donors with benign primary brain tumors and intra-thyroidal papillary microcarcinoma are acceptable. Meningioma does not display extra-cerebral metastasis, and thyroid papillary microcarcinoma is a common incidental finding during autopsy with rare distant metastases. Although autopsy in cadaveric organ donors is not routine, the presence of an unconfirmed primary brain tumor should prompt autopsy to exclude the presence of additional malignancies. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Department of Pathology and Laboratory Medicine, University of Puerto Rico School of Medicine. Department of Anatomic Pathology, ASEM. Life Link Puerto Rico, Inc.

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The Spectrum of Central Pontine Myelinolysis and the Role of Neuroimaging Ina Teron, Karina Méndez, Leyda G. Sánchez, Carmen Serrano, Luis García. University of Puerto Rico Medical Sciences Campus Background & Objectives: Central pontine myelinolysis (CPM) was first described in 1959, and little has been added to the clinical description since the original report. Known etiologies for this disorder include, chronic ethanolism, malnutrition, rapid correction of electrolyte disturbances, and association with liver transplant. Classic symptoms of CPM include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status ranging from locked-in syndrome, coma and death. We present an atypical case presentation of CPM. Methods: Review of medical chart, patient evaluation and neuroimaging. Results: In this case, a 57 year-old male with a history of chronic alcohol abuse, presented with tremors and an altered mental status of two-week progression despite being treated for delirium tremens. Neurologic exam remarkable for orientation in person only with ongoing visual hallucinations, generalized involuntary irregular tremors mostly affecting extremities and dysmetria without focal neurologic deficits. Laboratory results essentially unremarkable. Brain MRI revealed the typical triangular basis pontis lesion observed in CPM. Conclusion: This case denotes an atypical clinical presentation, lacking the usual severe neurological deficits of CPM. Less severe symptoms include confusion, delirium, hallucinations, and tremors which can be confused with delirium tremens. The latter brings about the consideration of an ample differential diagnosis in patients with chronic alcohol use who can present with a diversity of neurological problems. In this case Brain MRI findings helped to identify a case of subclinical CPM which must always be considered in the differential diagnosis in this group of patients. A-139

Constipation as Primary Presentation of Pediatric Chronic Pancreatitis Alvaro G. Reymunde, Ihosvani Barroso, Lianet Mamposo, Verónica Del Río-Villafañe, Leonardo Hormaza. San Juan City Hospital, Puetro Rico Background & Objectives: Chronic pancreatitis (CP) is defined as a process leading to irreversible destruction of the pancreatic parenchyma and loss of exocrine function. Most patients have a history of recurrent pancreatitis before the irreversible changes in pancreatic anatomy and function become apparent. Most cases are characterized by recurrent episodes of acute epigastric or diffuse abdominal pain, which may be associated with nausea and vomiting. Since these symptoms are a frequent complaint in children, childhood pancreatitis is a clinical diagnostic challenge. Methods: The incidence and prevalence of CP in children has not been clearly defined. In adults incidence has been reported anywhere between 5-10 cases per 10,000 in the United States. Up to 80% of cases were found to be secondary to alcohol abuse, an uncommon condition in pediatrics. In

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children, known causes include hereditary, metabolic disorder, trauma, cystic fibrosis, inflammatory bowel disease and anatomic anomalies. In about 50% cases a definitive cause is unclear and are termed “idiopathic”. Results: We present the unusual case of an 8 year-old male with history of bi-annual episodes of acute abdominal pain associated with constipation since 4 years ago. Patient was diagnosed with chronic pancreatitis after he was noted to have diffuse atrophy of the pancreas with extensive parenchymal calcifications on abdominal CT scan. Conclusion: Additional findings of dilation of the pancreatic duct, cyst at pancreatic tail and a fistulous communication to spleen were also found. MRCP revealed pancreatic duct dilatation with large intra-ductal calculus. The rarity of chronic pancreatitis with large calculus in the pancreatic duct is noted. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The authors have no conflict of interests, no funding sources and no disclosures to reveal at this time. A-140

Hip Injury in a Young Male Triathlete Juan C. Galloza-Otero, Mariella Hillebrand, Gerardo Miranda, Myriam Crespo, Carmen López-Acevedo. University of Puerto Rico Medical Sciences Campus Background & Objectives: To describe the case of a 30 y/o male triathlete who suffered a left intertrochanteric fracture after slow speed, low impact fall from bicycle due to the use of clipless pedals. Patient is a 30 y/o male triathlete without any systemic illness or previous injury that fell on his left side during a slow speed left sided turn on wet pavement. During the fall, he was unable to unclip his feet from the clipless pedal and consequently suffered direct trauma to his left hip. Methods: On initial examination he was complaining of severe pain in his left hip. The left leg was externally rotated with periarticular swelling. The left hip was tender to palpation, decreased passive and active range of motion due to pain. Imaging showed mildly displaced comminuted intertrochanteric fracture. He was taken to OR and intramedullary nail fixation was performed. Results: Initial differential diagnosis was more suggestive of a hip contusion, considering the mechanism of injury. Then physical exam and imaging studies showed the hip fracture. Conclusion: Hip fractures are disabling injuries and can occur from high impact trauma, or low impact falls in high risk population (post-menopausal women aged 50 years or older and on osteoporotic bone). Only 5 cases have been described regarding hip injury associated to the use of clipless bicycle pedals and the ages ranged from 37-43. Prevention of this types of injuries is an important factor to avoid disability. Adequate fitting and testing of the pedals is necessary. A-141

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A Case Series Of Peripartum Cardiomyopathy At The University District Hospital Laura C. Flores, Ronald López-Cepero, Josefina Romaguera, Anthony Osterman. University of Puerto Rico Medical Sciences Campus

Background & Objectives: Peripartum cardiomyopathy (PPCM) is an uncommon disease characterized by impaired myocardial function in pregnant women. It's associated to high morbidity and significant mortality. The etiology and risk factors for the condition are not well understood. Aim: To describe maternal morbidity and mortality of patients diagnosed with peripartum cardiomyopathy at the University District Hospital and to compare these with the published literature. Methods: Retrospective case series of patients diagnosed with PCM from 2006 to 2013 at UDH. Results: Seven cases were identified, one was diagnosed with PPCM antepartum and pregnancy was terminated after diagnosis, while the remaining were diagnosed postpartum. The mean ejection fraction upon diagnosis was 36 %. Two patients had premature deliveries. Two patients died from the disease in the postpartum period, one had other comorbidities (systemic lupus, scleroderma and rheumatoid arthritis). The other patient developed pneumonia, a deep venous thromboembolism and a wound infection. These comorbidities may have contributed to the progressive heart failure and eventually death in these cases. Characteristics of our patients as compared with the one reported in the literature coincide in: older than 30 years and multiparity. Due to the limited numbers of patients, a correlation between premature deliveries and PPCM cannot be adequately assessed. Conclusion: Since this is an uncommon disease, its etiology, risk factors, comorbidities and complications have not been well characterized. Larger multicenter studies to accurately assess the risk factors and etiology of PPCM as well as its outcomes in terms of maternal and fetal morbidity and mortality are needed. A-142

Pediatric autoimmune neuropsychiatric disorder associated with streptococci: A Case Report Yeira L. Rojas, Lourdes García. University of Puerto Rico Medical Sciences Campus Background & Objectives: The term known as PANDAS (pediatric autoimmune neuropsychiatric disorder associated with group A streptococci) is a rare syndrome that described a group of neuropsychiatric disorder that are exacerbated by group A streptococci (GAS) infection. The diagnostic criteria for this disorder include acute onset of obsessive-compulsive disorder and/or tic disorder, pediatric onset between 3 years and onset of puberty, abrupt onset and episodic course of symptoms and a temporal relation between a GAS infection and onset and/or exacerbation. Methods: In this report, we described a 5 years old healthy girl with the abrupt onset of obsessive compulsive behaviors 2 weeks after she was diagnosed with a pharyngitis that was accompanied by a generalized erythematous skin rash diagnosed as scarlet fever. Results: Patient was initially observed and admitted to institution to rule out any other etiology as encephalitis, but patient continues with worsening symptoms as she developed tics. Patient initially started in Risperdal therapy with minimally respond with

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eventually gradual respond to intravenous immunoglobulin. Conclusion: Patient was discharge home with Risperdal with follow up with the service of neurology. A-143

Programa Para Evaluar la Satisfacción con los Servicios de Salud General y Reproductiva en Mujeres sin Hogar Carlos G. Vergara-Herrera, Ilsia Y. Mundo, Mara Echavarria, Wilnelia Rivera, Ana M. Parrilla-Rodríguez. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: Las últimas décadas de estadísticas sobre la mujer sin hogar (MSH), señalan ésta se ha convertido, en el segmento poblacional de mayor crecimiento. Múltiples circunstancias provocan esta situación, particularmente en edad reproductiva, creando un serio problema de salud pública general y particular de esta población; desconociéndose la calidad de servicios de salud ofrecida. Implantar un plan para evaluar la satisfacción con los servicios de salud general y reproductiva, de las MSH en el Programa Para Personas Sin Hogar, Departamento de Desarrollo Comunal (DDC) del Gobierno Municipal Autónomo de Carolina (GMAC). Methods: Se revisó la literatura, se analizaron prioridades y criterios, desarrollándose un plan para implantar y evaluar la satisfacción con los servicios de salud general y salud reproductiva de las mujeres sin hogar, en la agencia seleccionada utilizando un instrumento creado y validado para ello. Results: Al presentar el plan de implantación a la organización seleccionada, ésta mostró sumo interés en adoptarlo. Según los hallazgos de la entrevista, el personal profesional del programa y la agencia poseen las destrezas necesarias de adaptación a los cambios sugeridos. Además, el programa cuenta con el apoyo necesario para desarrollar nuevas estrategias, basadas en evidencia científica, dirigidas a atender oportunidades relacionadas con proyectos en salud pública de madres y niños. Conclusion: Resulta viable implantar el Plan, e integrar recursos y análisis académicos con los de la Sociedad. Beneficiaría a la población total y a la MSH, en particular. Identificamos alianzas facilitadoras de las condiciones actuales de los servicios prestados a las MSH. A-144

Evaluación del impacto del Programa de Salud del Viajero en la comunidad universitaria UPR-RP Víctor H. Quiroz-Naranjo, Víctor E. Reyes-Ortiz. Universidad de Puerto Rico Recinto de Río Piedras Background & Objectives: La Universidad de Puerto Rico es posiblemente la institución gubernamental puertorriqueña que presenta mayor desplazamiento internacional entre los miembros de su comunidad. Las razones para esto obedecen al intercambio académico, social y cultural que le es propio a una institución de esta naturaleza. Es la intención que esta comunidad esté debidamente preparada para hacer frente a los retos de salud que conlleva estar en lugares tan próximos como el Caribe o tan distantes como Asia o África. A tales efectos, el

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objetivo de esta ide lnvestigación fue medir el impacto de un Programa de Salud en Viajes a comunidad de la Universidad de Puerto Rico, Recinto de Río Piedras. Methods: Siguiendo las guías de la OMS y el CDC se realizó una evaluación holística de los riesgos grupales, seguido por una comunicación oral y escrita de los riesgos de salud al realizar el viaje. Por último, se manejaron los riesgos individuales mediante la selección/administración de tratamientos y educación al paciente. Al cabo de aproximadamente 6 meses se encuestó a los participantes sobre cómo la intervención de salud había cambiado el conocimiento, sus comportamientos de salud y si habían sufrido alguna condición de salud. Results: Los resultados muestran que la intervención de salud logró modificar el conocimiento y las conductas de riesgo de entre el 75 – 90% de los participantes. De igual forma, solo el 6% de los participantes tuvo complicaciones de salud al estar en un escenario internacional. Pruebas de ANOVA muestran que no hubo diferencias significativas del impacto de las intervenciones luego de ajustar por los países visitados, haber buscado información previamente o haber visitado el país anteriormente, edad o género de los participantes (p > .05). Conclusion: Independientemente de las características sociodemográficas de los participantes del Programa y sus experiencias previas luego de la intervención, todos/as reportaron cambios en conocimiento y modificación de conductas de riesgos teniendo un mejor estado de salud durante la travesía. A-145

Preparacion de Planes de Emergencias para las Facilidades de Salud de Puerto Rico, 2011-2013 Ana M. Mercado-Casillas, Liza I. Millán-Pérez, Patricia E. Monserrate-Vázquez, Yari Valle-Moro, Ralph Rivera-Gutierrez. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: La vulnerabilidad de Puerto Rico a diversas amenazas de origen natural y humano requiere que las facilidades de salud estén preparadas. Para esto es necesario que cuenten con planes de emergencias que les ofrezcan un nivel de preparación y una capacidad de respuesta adecuados para atender a la ciudadanía, particularmente ante eventos con víctimas en masa. El objetivo principal del proyecto fue capacitar el personal clave de las facilidades de salud de Puerto Rico en el desarrollo de tres planes de emergencias: Plan de Descontaminación en Masa, Plan de Desalojo y Plan de Mortalidad en Masa. Methods: Se diseñó una serie de adiestramientos en múltiples sesiones y utilizando diversas estrategias didácticas para el desarrollo de los tres planes. Las estrategias educativas incluyeron: conferencias, ejercicios de mesa, redacción, discusiones de grupo, consultoría telefónica y electrónica, mentoría individualizada, presentaciones de los participantes y exámenes cortos, todas empleadas en múltiples sesiones grupales e individuales. Results: Unas 65 facilidades de salud, distribuidas en las siete regiones del Departamento de Salud, fueron impactadas en la capacitación. La gran ma-

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yoría de las facilidades participantes sometieron borradores finales de los planes al culminar la capacitación. Sobre un 90% de los participantes manifestaron que los adiestramientos consiguieron alcanzar su objetivo y lo recomendarían a otros profesionales. Conclusion: La estrategias didácticas y de múltiples sesiones empleadas en el proyecto demostraron ser efectivas en la preparación de la audiencia en el desarrollo de planes de emergencias. Se continúa ofreciendo seguimiento a algunas de estas instituciones para asistirles en la culminación de los planes. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Este proyecto fue sufragado en un cien por ciento por una subvención federal de la Oficina del Sub-Secretario para Preparación y Respuesta (ASPR, por sus siglas en inglés) del Departamento de Salud y Servicios Humanos federal administrada por la Oficina de Preparación y Coordinación de Respuesta en Salud Pública (OPCRSP) del Departamento de Salud (DS) de Puerto Rico. A-146

Retos en facilidades de salud de Puerto Rico para desarrollar un plan de descontaminación en masa Liza I. Millán-Pérez, Ana M. Mercado-Casillas, Iván García-Muñiz, Roberto Portela-López, Ralph Rivera-Gutierrez, Julianne Miranda-Bermúdez. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: En la fase de planificación para la preparación y respuesta a emergencias no sólo se fomenta el manejo de desastres naturales sino que se consideran emergencias creadas por el hombre. Puerto Rico es vulnerable a un evento de contaminación en masa. La respuesta a estos podría requerir una descontaminación de las víctimas en las salas de emergencias de las facilidades de salud; protocolos de seguridad deben ser implementados. Las facilidades deben tener los recursos, el personal y el peritaje para realizar una descontaminación de emergencia. Existen retos para estas facilidades lograr planificar y desarrollar un plan efectivo. Los objetivos del proyecto fueron adiestrar y capacitar a facilidades de salud de la Isla en el desarrollo del plan de descontaminación en masa y recopilar información sobre los retos que experimentan. Methods: Se diseñó un adiestramiento en 2 fases, 4 sesiones cada una. Se ofreció en las 7 regiones del Departamento de Salud. Se utilizaron varias estrategias educativas para lograr la capacitación de los participantes. Results: 65 instituciones de salud y 212 personas participaron del proyecto. Se desarrollaron 54 borradores del plan de descontaminación en masa. Se documentaron los retos que presentaron los participantes para desarrollar e implementar el plan y las necesidades de equipos y de personal capacitado. Conclusion: Existe una gran necesidad de adiestramientos continuos sobre desarrollo y preparación de planes de descontaminación en masa ya que la mayoría de las facilidades de salud de Puerto Rico enfrentan serios retos para lograr responder efectivamente a una emergencia de este tipo. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): A todo el equi-

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po del Centro de Preparación en Salud Pública del Recinto de Ciencias Médicas de la Universidad de Puerto Rico, por su gran apoyo y aportación durante la implementación del proyecto. En especial, al Sr Iván García Muñiz, por su disponibilidad y excelentes recomendaciones durante el proceso de desarrollo e implementación de esta investigación. A-147

Non-STEM Undergraduates Engaged in Active Learning through Molecular Biology Laboratory Experiences Gerardo Arroyo-Cruzado, Jorge E. Rodríguez-Echegaray, Carlos I. Ayarza-Real. University of Puerto Rico Río Piedras Background & Objectives: The Department of Biological Sciences (DBS) is offering a novel introductory course Science, Biotechnology and Society (CIBI 3028), to introduce nonSTEM undergraduates to biotechnology and the new trends in this scientific field. Scientific methodology, chemistry of life, cell physiology, molecular biology and biotechnology are the main topics in CIBI 3028 presented from an interdisciplinary approach. The students are engaged in active learning, which will be involving themselves in the discussion of current socioeconomic, environmental and bioethical issues related to biotech. As part of the laboratory component, students perform a novel sequence of experiences in basic microbiology and DNA technology resembling a research project. Methods: The non-STEM students are randomly enrolled in CIBI 3028. Participants knowledge and comprehension achievement are evaluated through pre-test/post-test on scientific aspects such as experimental design and fundamentals in DNA technology. A pre/post questionnaire was administered to evaluate the transition in their level of interest towards postgraduate and professional commitments. Results: The pre-test/post-test show significant gain in outcomes in knowledge and comprehension. Meanwhile, pre/post questionnaire shows remarkable increase in the participant interest towards post graduate and professional commitments. The questionnaire posed items that allowed the authors to correlate the student interest transition to their participation in the course and laboratory experiences. Conclusion: The authors are working to validate an assessment instrument, which consider students attitudes and values towards Biosciences and Biotech research. This would be the first step to study the possibility to integrate an authentic research project in the CIBI 3028 laboratory component. A-148

Estudio sobre eventos de desalojo reportados por las facilidades de salud en Puerto Rico (20112013) Patricia Monserrate-Vázquez, Ana M. MercadoCasillas, Ralph Rivera-Gutierrez, Nannette M. LugoAmador, Juan González-Sánchez. Universidad de Puerto Rico Recinto de Ciencias Médicas

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Background & Objectives: La planificación para el desalojo en una facilidad de salud es un componente crítico y esencial en el desarrollo de un plan integral de emergencias. Durante un desalojo, la seguridad y salud de los pacientes, visitantes y personal es fundamental. Hasta este proyecto, no se había realizado un estudio para documentar las experiencias de desalojo en las facilidades de salud en Puerto Rico y las lecciones aprendidas de estos. Recopilar y analizar información sobre la experiencia de eventos de desalojo de facilidades de salud en Puerto Rico. Methods: Se desarrolló el cuestionario Experiencia de Desalojo, que recoge información sobre eventos de desalojos que han experimentado las distintas facilidades de salud. El cuestionario consiste de quince preguntas sobre: el año de desalojo; razones; tipo de desalojo; tiempo que tomó el mismo; medios utilizados; lugares de movilización; y lecciones aprendidas. Results: Un total de sesenta y un (n=61) facilidades de salud completaron el cuestionario de las sesenta y cinco (n=65) que participaron en el proyecto desarrollado por el CPSP-UPR. El 64% reportó haber tenido que desalojar en al menos una ocasión. Durante el proyecto, se documentaron sesenta y ocho (n=68) eventos de desalojo, en las instalaciones de salud. Conclusion: Este análisis demuestra la frecuencia con que han ocurrido eventos de desalojo en facilidades de salud en Puerto Rico. La recolección de datos permite conocer y analizar información importante sobre este tipo de eventos, contribuyendo al mejoramiento de los esfuerzos de preparación en las instalaciones de salud de la Isla. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): A todo el equipo del Centro de Preparación en Salud Pública del Recinto de Ciencias Médicas de la Universidad de Puerto Rico, por su gran apoyo y aportación durante la implementación del proyecto. En especial, a la Dra. Nannette M. Lugo Amador por sus excelentes recomendaciones y disponibilidad consistente hasta completar esta investigación. A-149

Percepción del adulto mayor en Puerto Rico sobre el consumo excesivo de medicamentos Tiffany L. Pérez, Carmen L. Madera. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: Para el 2050, se espera que 39% de la población sea de adultos mayores (Censo, 2010). Con el aumento en la población de edad avanzada ha aumentado el consumo de medicamentos (Shah y Hajjar, 2012). El uso excesivo de medicamentos puede provocar reacciones adversas y uso inapropiado (Holmes, 2012). Para estudiar esta situación, se trabajó el siguiente objetivo: describir la percepción del adulto mayor sobre el consumo excesivo de medicamentos e identificar factores que influencian su percepción. Methods: Diseño descriptivo, por disponibilidad. Se recogieron los datos en octubre del 2013 con una muestra de 40 participantes mayores de 65 años, no dependientes a cuidados de salud. El instrumento utilizado diseñado por la investigadora titulado: “Estimado de percepción del consumo excesivo de medicamentos en adultos mayores”. Results: De los 40 participantes, 25 (62%) presen-

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taron una percepción adecuada y 15 (38%) una percepción moderadamente adecuada. La muestra indicó un consumo promedio de 6 medicamentos diarios. El 57% contestó estar totalmente de acuerdo y de acuerdo con que el tomar té no afecta las demás medicinas ya que éste es natural y un 60% indicó que toma todas las medicinas a la vez en la mañana para que no se le olvide ninguna. Conclusion: Los resultados sugieren desconocimiento particularmente sobre las interacciones entre los medicamentos convencionales y naturales. La memoria puede considerarse un factor que interfiere con la ingesta correcta de los medicamentos. Se recomienda un estudio que considere obtener información sobre consumo de medicinas naturales y convencionales. A-150

An Assessment of the Neurology Research Curriculum during the 2009 to 2013 Leticia Rodríguez-Cruz, Carmen Serrano, Valerie Wojna. University of Puerto Rico Medical Sciences Campus Background & Objectives: In 2009, the Neurology Training Program reviewed and established a new research curriculum to promote the research participation of the neurology residents and faculty to fulfill the ACGME requirements in research experience. Prior to 2009, the Neurology residents had a limit exposure to research where most works consisted of case presentations. This responsibility was delegated to the Research Committee, who developed the curriculum and designed the strategies as part of the Neurology Training Program curriculum. Methods: The curriculum included a basic principles research course, guided the residents in the research design and development, and supported the faculty mentors. All senior residents completed the research project including generating a proposal, IRB approval, data gathering and analysis, and presentation. The Research Committee monitored the resident’s research activity by monthly meetings and follow up with their mentors. A mentor’s form was implemented document all activities. Results: During 2009 to 2013, the residents’ participation in scientific meetings increased significantly (62%). Overall, between faculty and residents, there were 64 presentations among them: RCM Research Forum (24), American Academy of Neurology Annual Meeting (9), American Epilepsy Society (5), ISNV (5), and SNIP (5). Several awards were obtained included special presentations and highlight discussions in focal groups. This work generated 27 manuscripts (93%), 25 of them were peer review in 16 journals. Conclusion: The research activity in the Neurology Training Program significantly increased over the past five years supporting that the strategies implemented were effective. These positive outcomes placed the Program in compliance with the ACGME requirements. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): We thank the Neurology Research Committee, Dr. Carlos Luciano (Chair, Neurology Section), Neurology Faculty and Neurology Residents.

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A-151

Advanced Communication Skills During The Pediatrics Clerkship: A Five Year Experience Nerian Ortiz, Yasmin Pedrogo, Debora Silva, Nydia Bonet. University of Puerto Rico Medical Sciences Campus Background & Objectives: Being competent in basic and advanced communication skills is an accreditation requirement and a licensing requirement. The Association of American Medical Colleges has recommended that advanced clinical skills should be taught and assessed throughout the medical school curriculum.. Basic skills are taught and assessed during the first two years of medical school and the advanced skills during third year. Few articles are found on curricula to train students for difficult situations. Describe the Pediatrics Clerkship educational strategy in which students demonstrate advanced communication skills. Methods: A formative clinical experience using standardized patients has been integrated to the pediatrics clerkship. Two 20-minute clinical scenarios have been developed: a mother who is not satisfied with services offered; and the parents of a baby refuse immunizations due to a recent acute life threatening event. Feedback on performance was offered. Results: During 2008-2013 a total of 475 medical students enrolled in the Pediatrics Clerkship have completed the activity. Students agree the experience is relevant to the medical practice (95%). Students perceive adequate difficulty level (85%). Students perceive that previous courses prepare in advanced communication skills (81%). A hundred percent of the students find valuable the feedback. Conclusion: The strategy using standardized clinical scenarios to teach advanced communications skills during the pediatrics clerkship serve as a tool to reinforce competency among medical students. Students perceive the activity as necessary. As a formative exercise allows the student to engage in the learning experience in a stress-free environment and prepare them for the realism of patient care in challenging situations. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Clinical Skills Center, University of Puerto Rico School of Medicine A-152

Transitioning to Smart Rooms on Campus Arlene Sánchez-Castellano, Elizabeth Román-Rivera, Carmen Colón-Santaella, Luz Muñiz-Santiago, Ruben García-García. University of Puerto Rico Medical Sciences Campus Background & Objectives: The teaching learning process in higher education is been transformed by the use of innovative technology. One component of Title V project funded smart rooms’ technology for three of six medical sciences schools on campus. Faculty satisfaction with the use of this media was assessed. Objective: An assessment strategy was implemented to evidence outcomes on two Title V project objectives: 1) increase the number of faculty integrating technology into teaching learning process and 2) improve the instructional and technological support facilities. Methods: An electronic sur-

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vey was designed and administered to 157 faculty members from participating schools after training sessions on mobile devices, wi-fi components, and smart boards. Ten questions were included: nine closed questions probed satisfaction and one open ended question gathered recommendations on how to improve the use of smart rooms. Results: Response rate was 30 %. Respondents stated they use smart boards (48%), have integrated the use of smart rooms to the teaching learning process (60%), felt confident of new skills (48%), needed additional training (73%); and rated quality of equipment as excellent (70%). Salient recommendations were: additional hands-on training sessions to maximize the use of this technology in teaching; improve access to technological support; provide specialized training to support personnel; and further improve infrastructure to facilitate the implementation of technology. Conclusions: Faculty seems to be eager to integrate smart room technology to the teaching learning process. To enhance and keep up faculty engagement an ongoing training process is recommended both for faculty and technical support staff. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Supported by the US Department of Education: Title V Grant Award Number# PO31SS100092 A-153

Estudio sobre el consumo de alcohol en menores de Vega Baja Wanda E. Pérez-Rodríguez, Zeleida M. VázquezRivera, Víctor E. Reyes Ortiz. Universidad de Puerto Rico Recinto de Ciencias Médicas; Programa Barrio Vivo-Iniciativa Comunitaria Background & Objectives: El consumo de alcohol en menores es socialmente aceptado en PR. Para fortalecer la infraestructura de prevención a nivel comunitario y prevenir el consumo de alcohol en menores; Iniciativa Comunitaria (ICI) con su programa Barrio Vivo participa del PR Strategic Prevention Framework – State Incentive Grant. Con el fin de conocer factores de riesgo y protección de los jóvenes y monitorear el impacto de un plan estratégico de prevención de alcohol, se realizó una encuesta en escuelas de Vega Baja. Objetivo: Presentar los datos sobre el consumo de alcohol por menores de Vega Baja. Methods: Se seleccionaron aleatoriamente 10 grupos en cada una de las 4 escuelas que participaron en la Encuesta Juvenil. Los cuestionarios fueron desarrollados por el Puerto Rico Epidemiological Outcome Group y administrado por el personal de Barrio Vivo durante el 2012. Results: Se encuestaron 309 estudiantes. El 53.4% indicó el alcohol como la sustancia más utilizada en algún momento de su vida. El 42.6% indicó que consumió alcohol durante el pasado año. El 66.7% inició el consumo de alcohol antes de los 15 años. El 53.4% percibe que se le haría fácil conseguir bebidas alcohólicas y el 85.4% de los que consumieron alcohol informó que no se le pidió identificación a la hora de comprar la bebidas alcohólicas. Conclusion: El consumo de alcohol por los menores y su fácil acceso es una problemática social existente en Vega Baja que justifica el desarrollo de un plan estratégico de prevención

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de alcohol a nivel individual y ambiental. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): ASSMCA es el auspiciador del proyecto Barrio Vivo. A-154

Implementing a “Learning Styles Questionnaire” as a Learner Diagnosis Tool within the Pediatrics Residency Program María E. Padilla, Yasmin Pedrogo. University of Puerto Rico Medical Sciences Campus Background & Objectives: In medical education, there is now more awareness that residents are self-directed life-long learners who must take ownership of their own learning experiences. In their Individual Learning Plans (ILP), they are expected to establish academic objectives and to design learning experiences in accordance. The development of the ILP is viewed by residents as just another requirement and the result is a plan full of unspecific learning activities and goals. The aim of this project is to identify a learner assessment instrument that provides practical information that residents can use to design a more complete ILP. Methods: Three pediatrics residents completed five Learning Styles assessment instruments and selected the survey they found to be most practical. A learning activities toolbox was then designed to match each possible learning style. Afterwards, ten residents completed the survey and used the toolbox to design their ILP. A focus group with these residents and the Program Director (PD) ensued to evaluate these tools’ effectiveness. Results: Residents strongly favor using a learning styles assessment as a tool to enhance self-awareness and emphasized the importance of having a toolbox available to use as guidance in developing learning activities. The PD reported that the residents wrote more specific and detailed objectives than in their initial plans. Conclusion: This activity increases the residents’ understanding of the concept of an ILP and it probably enhances compliance with this program requirement. Residents were extremely satisfied with these tools and recommend their formal implementation in the residency program. A-155

Profiling Puerto Rico’s Environmental Threats using Local Newspapers Johel Padilla-Villanueva, José R. Rivera-Torres, Jessenia D. Zayas-Ríos, Victor Emanuel Reyes-Ortiz. University of Puerto Rico Medical Sciences Campus Background & Objectives: Environmental threats (ET) are one of the most relevant concerns worldwide. Indeed healthy people 2020 recognize the urgency of working with ET at a community level. The aim of this research was to observe the most relevant ET being documented in the 3 most relevant Puerto Rico newspapers. Also this research intended to contrast documented ET against published scientific research made by environmental health practitioners. Methods: Following the communication theory, six months cross-sectional research was made to analyze what ET were being communicated to the civil society. Only news related to Puerto Rico were included in the analysis excluding news documenting ET’s taking place elsewhere. Results:

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Results were tabulated using STATA 12.0 showing that most of the ET being documented were related to policy and regulation violations/complaints (23.42%) and emergency preparedness issues (17.10%). These were followed by environmental epidemiology (14.75%) and solid and liquid wastes management (11.24%) news. Higher volumes of this news were reported among the moths of September and October having a lower report by December. After contrasting the information in newspapers to against published scientific research made differences were observed, showing discrepancies in research priorities and ET impacting communities. Conclusion: In conclusion, civil society is being informed of ET events that seem to lack or had inappropriate legislation posing the need to increase the environmental policy evaluation projects in the island. These concerns should endeavor environmental health practitioners in order to be aligned to Healthy People 2020 objectives. A-156

Modelo y Efectividad del Programa de Desarrollo de Facultad del DIDARP-Escuela de Salud Pública Lourdes M. Torres-Baez, Antonio Méndez-Iglesias. Universidad de Puerto Rico Recinto de Río Piedras; Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: Desarrollarse en el ámbito académico implica el reto de mantenerse a la vanguardia en la adquisición y producción de conocimiento científico. Por tanto, resulta imprescindible contar con programas de capacitación que promuevan la inmersión de profesionales y estudiantes a la comunidad científica. Esta propuesta presentará el modelo y efectividad del Programa de Desarrollo de Facultad del DIDARP-Escuela de Salud Pública. Methods: Con un modelo basado principalmente en los principios de la andragogía y mentoría, el programa se vale de diversas estrategias instruccionales tales como talleres, group meetings, seminarios, Journal Clubs y web-based tools, entre otros. Estos buscan desarrollar 5 dominios principales de competencia en investigación que incluyen conocimiento científico, destrezas de investigación, comunicación, liderazgo y ética. Results: Al presente el programa ha ofrecido un total de 11 talleres, 8 seminarios, 11 Journal Clubs entre otras actividades educativas, adiestrando y desarrollado a un total de 13 investigadores, 29 estudiantes y 1 Post-Doc, aproximadamente. Generando así un espacio para que facultativos jóvenes y estudiantes graduados aumenten su capacidad en investigación relacionada al abuso de sustancias y justicia criminal en Puerto Rico. Herramientas evaluativas que van desde planes de desarrollo hasta reuniones y evaluaciones individuales dan cuenta de la efectividad de las diferentes estrategias utilizadas reportando entre un 75% a 100% de efectividad. Conclusion: Los resultados de diferentes estrategias de evaluación reflejan la efectividad y fortalezas del programa y sus actividades, destacando el impacto del mismo en el desarrollo de capacidades en investigación relacionada al abuso de sustancias y justicia criminal. Acknowledgements (Funding Sources, Conflict of

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Interests Disclosures, etc.): Diversity-Promoting Institutions Drug Abuse Research Program de la Escuela de Salud Pública RCM (DIDARP), Auspiciado por NIDA bajo la propuesta 2R24DA024868-03. Centro de Investigación y Evaluación Sociomédica A-157

Estudio de audiencia para diseñar una campaña a comerciantes para prevenir el alcohol en menores Zeleida M. Vázquez-Rivera, Wanda E. Pérez-Rodríguez, Víctor E. Reyes-Ortiz. Programa Barrio VivoIniciativa Comunitaria Background & Objectives: El desarrollar campañas de Mercadeo Social (MS) permite tratar problemas sociales a través de diversas estrategias. Iniciativa Comunitaria con su programa Barrio Vivo fue una de las organizaciones seleccionadas para implementar el Modelo de Prevención Estratégica de PR. Como parte del plan a nivel ambiental se diseñó una campaña de MS para comerciantes con el fin de prevenir el consumo de alcohol en menores de Vega Baja. Objetivo: Presentar un estudio de audiencia realizado a comerciantes del pueblo de Vega Baja para el desarrollo de una campaña que prevenga el acceso a bebidas alcohólicas a menores. Methods: Se reclutaron comerciantes cuyos negocios se encuentran en la jurisdicción del Código de Orden Público de Vega Baja. Los instrumentos fueron administrados en forma de entrevista por personal de Barrio Vivo. Results: Catorce comerciantes completaron los instrumentos. 36.4% de los comerciantes estaban solteros. 63.6% completaron un grado técnico. Los medios que más utilizan para comunicarse e informarse son el celular y la televisión. Se observó que ninguno de los comerciantes conoce a cuánto asciende la multa por vender alcohol a un menor, la mayoría desconoce los metros de distancia que debe estar una escuela de una barra y no piden identificación. A la hora de recibir información les interesa que sea a través de material impreso y orientación directa al negocio. Conclusion: Para desarrollar una campaña de MS es imprescindible conocer el perfil y comportamiento del mercado meta. Además, permite priorizar las estrategias a utilizar para impactar a la audiencia. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): ASSMCA es la organización que auspicia el Programa Barrio Vivo. El Centro de Investigación y Evaluación Sociomédica (CIES) es la organización que colabora y proporciona apoyo al Programa Barrio Vivo. La organización ILACS que nos apoyó en el diseño de la campaña de Mercadeo Social. A-158

Conocimiento de estudiantes en el Manejo de Dolor de pacientes con cáncer Nayla R. Melamed, Carmen L. Madera-Ayala. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: El manejo del dolor como tema de investigación ha tomado gran auge (Messmer, 2009; Zavala Rodríguez, 2008; Sánchez Sánchez, 2005; Torres Reyes, 2012).

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Los profesionales de la enfermería, desde que son estudiantes deben aprender a manejar adecuadamente el dolor, particularmente en el paciente de cáncer. Este estudio contestó la siguiente interrogante: ¿Cuál es el nivel del conocimiento que poseen los estudiantes de cuarto año de bachillerato enfermería sobre el manejo del dolor en pacientes con cáncer? Los objetivos de la investigación fueron describir el nivel de conocimiento que poseían los estudiantes de cuarto año de bachillerato de enfermería. Methods: Estudio de diseño descriptivo, transversal (Polit, 2012) con una muestra por disponibilidad de 50 participantes de una población accesible de 100 estudiantes de cuarto año de bachillerato de enfermería de una escuela acreditada. El instrumento de medición (alpha de Cronbach de .80) fue: “Encuesta sobre el conocimiento y actitudes con relación al dolor”. El proyecto aprobado por el IRB, recogió los datos durante el mes de octubre 2013. Results: Los participantes estuvieron entre las edades de 21 y 26 años de edad, con una media de 22. De acuerdo a las puntuaciones de la prueba, solo tres (3) participantes, un 6% de la muestra aprobaron la prueba con 70% o más. Conclusion: Se recomienda repetir este estudio con estudiantes de otras instituciones educativas y trabajar más con este tema en los currículos de enfermería. A-159

Conocimiento, Creencias, Actitudes y Deseo de Promover la Lactancia en Estudiantes de Enfermería Ruth M. Figueroa, Carmen L. Madera-Ayala. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: Una de cada cuatro madres se queja de no haber recibido ayuda o apoyo para la lactancia de parte del personal hospitalario (Cabrera, 2010). Para determinar si los estudiantes de enfermería poseen la preparación y deseo de ayudar a las madres lactantes se contestó la siguiente interrogante ¿Cuál es la relación entre el conocimiento, las creencias, las actitudes sobre la lactancia materna y la deseabilidad de promoverla que poseen los estudiantes de cuarto año de bachillerato de una intuición en el norte. Objetivos: Examinar las actitudes y creencias de los estudiantes en torno a la lactancia materna, determinar su nivel de deseabilidad para promoverla y establecer la relación entre el conocimiento, creencias, actitudes y deseabilidad. Methods: La muestra por disponibilidad estuvo constituida por 49 estudiantes de cuarto año de bachillerato mayores de 21 años. Los datos se recogieron por medio de dos instrumentos de medición. Results: Un 33% de los participantes logró completar el cuestionario de conocimiento de manera satisfactoria mientras que un 67% no lo aprobó. Un 93.6% indicó que es importante proveer apoyo a las madres lactantes, el 84.8 % lo consideró necesario mientras que un 87.2% opinó que es importante que la madre y el bebé logren el éxito en la lactancia materna. Conclusion: Los participantes tienen el deseo de promover la lactancia materna independientemente posean el conocimiento suficiente. Consideran importante que la madre y él bebe tengan éxito en el lactancia materna, siendo ellos una fuente de apoyo, teniendo una actitud positiva hacia la misma.

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Implementation of the Pediatric Early Warning Score System to identify patient deterioration Kristie M. Rodríguez-Otero, Anabel Puig, María Villar-Prados, Milagros Martín de Pumarejo, Giancarlos Lugo, Gilberto Puig-Ramos. University of Puerto Rico Medical Sciences Campus Background & Objectives: Hospitalized pediatric patients are at increased risk for deterioration that could end in cardio-respiratory arrest. Efforts shifted to develop an objective tool to identify early signs of deterioration before it requires the activation of a Rapid Response.. Our Study is a Pilot observational design that measure effectiveness of the PEW Score on quantifying severity of illness in pediatric patients on the University Pediatric Hospital. Methods: PEW score range from 0-11 and focus on three components: Child behavior, Cardiovascular status, Respiratory status. On the Education phase , nurses of pediatric ward were trained in how to use PEW score .On the Implementation Phase, Nurses were instructed to calculated the pew score to each new admission to ward, once in a shift of 8 hour, unless patient deteriorates. Results: Of 24 new admissions 54% were found to had a pew score of 0, 29.1% had a pew score from 1-2 and 16.6% had a pew score from 3-6, from which 12.5 % were transferred to ICU. In 20%, pew score was not calculated on the night shift. Conclusion: Rapid Response activations decreased from 3 to 0 during implementation compared to last year. It can be Attributed to the fact that all patients with higher pew score (>6) were admitted to ICU before an activation occurs. Effectiveness of tool was affected when nurses fail to calculated the pew score .We conclude that Pew score support early recognition of deterioration when collected adequately. A-161

Evaluación de Adherencia a Bifosfonatos en Mujeres con Osteoporosis en Farmacia de Comunidad en P.R. Maryelis González, Francisco J. Jiménez, Betty A. Torres. Universidad de Puerto Rico Recinto de Ciencias Médicas Background & Objectives: La osteoporosis es una condición que afecta a 200 millones de personas en el mundo y 44 millones en EU. Se caracteriza por la disminución en la densidad ósea, resultando en fracturas. Los bifosfonatos son la primera línea de tratamiento aprobada. La mayoría de los pacientes no se adhieren a éstos por experimentar efectos adversos gastrointestinales, frecuencia de administración y falta de conocimiento. El propósito es evaluar la adherencia a los bifosfonatos, en una población de féminas en la Farmacia San José en Lares, P.R. Methods: La adherencia fue evaluada utilizando la escala de Morisky, validada para adherencia a medicamentos orales para tratar osteoporosis. Las féminas mayores de 50 años que vistan la Farmacia fueron invitadas a participar en este estudio descriptivo. Results: El 57% de las participantes reportó olvidar tomar el bifosfonato por su frecuencia de administración. El 70% tomó el bifosfonato en las últimas 4 semanas. El 54% indica que dejó de

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tomarlo cuando sintió que no le funcionó porque desconocen el efecto del mismo. El 53% reportó que siente presión al adherirse a su tratamiento y de vez en cuando se le dificulta acordarse tomarlo. Conclusion: La adherencia a los bifosfonatos se ve afectada debido a la falta de conocimiento sobre el efecto de estos en el tratamiento. La frecuencia de administración es otra de las razones principales. En el futuro se considera evaluar el impacto en la adherencia al tratamiento de un programa educativo sobre la osteoporosis y los bisfosfonatos. A-162

"Caminando sin Estrés" CaSE: A Health Promotion Program Lourdes E. Soto de Laurido. University of Puerto Rico Medical Sciences Campus Background & Objectives: Caminando sin estres is a project of health promotion. It is an initiative of IIPESAG to control the stress in the participants. It has been implemented on three occasions to complete the health promotion design and set the priorities for intervention. Caminando sin estres combined the weight control with exercise and good habits that can help to reduce the level of stress among participants. The objectives were: To identify indicators of the levels of stress. Contemplating integrate physical activity in the daily work. Change dietary habits. Methods: Employees of the Medical Sciences Campus were selected to participate in Caminando sin estres. Participants meet attended all educational activities and integrated all the recommendations into their daily lives. Some of these recommendations were to participate weekly in a group hike and in an educational activity. They received feedback during the process by the program facilitator and the program Director. Results: A group of ten (10) participants (walkers) was constituted. During the project the group used a distinctive logo that was represented through shirts, educational materials, a pedometer and a place matt (My PLATE). Indicators as: weight, body mass, food selection using " My Plate" for the selection of food, and the used of pedometers to count the steps to measure physical activity. Conclusion: After the program design and the definition of indicators Caminando sin estres (CaSE) will be state as a a research proposal to measure real changes in lifestyles and quality of life according with the indicators. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Graciela Marrero, Hector Rivera and Alexandra Concepcion A-163

A Programs’ Journey; MD PhD Combined Program between UPR MSC School of Medicine and UT M.D. Anderson Ilka C. Rios, Elizabeth Travis. University of Puerto Rico Medical Sciences Campus; UT M.D. Anderson Cancer Center, United States of America Background & Objectives: The main objective of the combined Program is to develop a critical mass of physician-scientists who will lead cancer research, prevention and treatment in Puerto Rico. The collaborating institutions are: the UPR-Me-

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dical Sciences Campus (MSC) and UT MD Anderson Cancer Center (MDACC). Methods: The Program formally started on 2008 with an interinstitutional agreement. The MD/PhD Program’s structure is focused on translational research. The students earn the MD degree from the UPR-MSC School of Medicine (SOM), and the PhD degree from the UT Graduate School of Biomedical Sciences (GSBS) and MDACC, at Houston. A student must complete the 3rd year of the MD prior to starting the PhD, thus providing strong basis in clinical medicine that allows the trainee to conduct translational research. The student’s recruitment starts in college with annual visits to the UPR Campuses. Results: Currently there are 15 students at the Program’s pipeline; 8 at the SOM & 7 at UT GSBS and MDACC. Most of the students are conducting research with a Cancer Biology Major. The first 2 students will be completing the dual degree by May 2014. Conclusion: The success of this program relies in recruiting outstanding trainees, world renowned mentors and the dedication of the support personnel. The expectation is for the alumni of the Program to hold a faculty appointment at the UPR Cancer Center, for the improvement of the health and the availability of the best diagnostic and treatment protocols for cancer patients in Puerto Rico. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): NIH NCI U54 Grant CA096297. A-164

Drugs and Alcohol: Their Relative Crash Risk Pedro A. Torres-Saavedra, Eduardo Romano, Voas B. Robert, Lacey H. John. University of Puerto Rico Mayagüez Campus; Pacific Institute for Research and Evaluation, Calverton, MD, United States of America Background & Objectives: To determine (a) whether among sober (BAC=.00%) drivers, being drug positive increases the drivers’ risk of being killed in a fatal crash; (b) whether among drinking (BAC>.00%) drivers, being drug positive increases the drivers’ risk of being killed in a fatal crash; and (c) if alcohol and drugs interact in increasing crash risk. Methods: We compared blood alcohol concentration for the 2006, 2007, and 2008 crash cases drawn from the U.S. Fatality Analysis Reporting System (FARS) with control drug and blood alcohol data from participants in the 2007 U.S. National Roadside Survey (NRS). Only FARS drivers from states with drug information on 80% or more of the drivers that also participated in the 2007 NRS were selected. Results: For both sober and drinking drivers, being positive for a drug was found to increase the risk of being fatally injured. When the “drug positive” variable was separated into “marijuana” and other drugs, only the latter was found to contribute significantly to crash risk. In all cases, the contribution of drugs to crash risk was significantly lower than that by alcohol. Conclusion: Although overall, drugs contribute to crash risk regardless of the presence of alcohol, such a contribution is much lower than that by alcohol. The lower contribution of drugs to crash risk relative to that of alcohol suggests the inadvisability of focusing too much on drugged driving, po-

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tentially diverting scarce resources from curbing drunk driving. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Support for this effort was provided by the National Institute on Alcohol Abuse and Alcoholism (Grant Nos. R21 AA018158 and R01 AA018352-02). A-165

Caries Experience of a Sample of PR Adolescents Rosana Hanke, Lydia M. López del Valle, George Taylor. University of Puerto Rico Medical Sciences Campus; University of San Francisco, California Background & Objectives: This cross sectional study of adolescents in Puerto Rico (PR) had aims to evaluate: (1) oral health status and (2) caries experience differences among obese, or overweight (OOVA) and healthy weight (HWA) adolescents. Methods: A convenience sample of 135 adolescents aged 13 to 18 years from 3 public schools were recruited. University of Puerto Rico’s IRB approved the study and the consent and assent were completed for each participant. A single visit dental evaluation was performed at the school by a calibrated dentist with ICDAS criteria. The dental evaluation consisted of plaque index, ICDAS caries exam. Height, weight and waist circumference were measured. Statistical analysis was performed using SPSS for descriptive statistics and chi square test. Results: For the Total sample: Mean age =16.5 years; DMFS 3-6 =5.79; DS3-6 =1.9, FS= 3.74; and 26.2% had sealants. For the DMFS index D3-6 =33%. OOVA composed 51% of the sample. OOVA mean age=15.6 years, 51.6% female. The OOVA DMFS 3-6=5.93; DS3-6 =1.98, FS=3.88. HWA mean age=16.37 years; DMFS 3-6=5.66, DS3-6 =1.94, FS=3.59. No statistically significant differences were found for DMFS, DS, FS indexes between OOVA and HWA (p >0.05). SIC index for OOVA was DMFS3-6=24.07, DS3-6 =5.2; 66% female. SIC index for HWA DMFS3-6=12.21; DS= 4.8; 73.7% female. Significant differences were found of obese and overweight children regarding SIC index (p < 0.05). Conclusion: No significant differences were found for the overall DMFS 3-6 for obese, overweight and healthy weight PR adolescents although specific caries analysis by SIC index highlighted poor oral health for obese and overweight PR adolescents. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): PR Trust of Research and Technology, Colgate Palmolive Research Donation and Triple S A-166

Characterization of the relationship between weight and periodontal disease in PR Adolescents Leila Soto-Villamil, Lydia López del Valle, George Taylor, Rosana Hanke. University of Puerto Rico Medical Sciences Campus; University of San Francisco, United States of America Background & Objectives: The aim of this cross sectional study was to evaluate the association of obesity and periodontal health status in a group of Puerto Rican (PR) adolescents. Methods: A convenience sample of 184 Puerto Rican (PR) adolescents ages 13 to 18 years from 3 PR public schools was recruited. The

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University of Puerto Rico’s IRB approved the study. A one visit dental evaluation was performed at the schools by a calibrated dentist. This evaluation included plaque index, ICDAS caries exam, bleeding on probing, probing pocket depth, and recession. Height, weight and waist circumference were measured. Statistical analysis was performed using SPSS. Results: Participants’ distribution was: obese (32%), overweight (16%), healthy weight (50%) and underweight (1.5%); females were 62%. Mean number of sites with bleeding on probing, severity grade 3 were greater for obese (5.10 ) than healthy weight (3.9). Mean number of sites with pocket depth = 4 mm and bleeding on probing > 20% was greater for obese than for healthy weight adolescents. No statistically significant differences were found for severity of bleeding on probing when comparing obese vs healthy weight participants (p = 0.94) Categorization by BMI showed no statistically significant differences for obese and overweigth subjects compared to healthy weigth participants and total number of bleeding on probing sites (p = 0.0.85); periodontal disease (3 or more sites with pocket depth greater than 4 mm) (p = 0.44). Conclusion: Although no statistical significant differences were found for main periodontal parameters and obesity in adolescence, greater values were found for obese and overweight adolescents than healthy weight subjects. Early signs of periodontal disease diagnosis in adolescence may need other definitions of periodontal disease specific for these age group. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): PR Trust of Research and Technology, Colgate Palmolive Research Donation, Triple 2 A-167

Prevalence of Malocclusion of PR Adolescents in Selected Public Schools Karla Alvarado, Lydia López del Valle, Rosana Hanke, Francis Picón, Sona Tumayan. University of Puerto Rico Medical Sciences Campus Background & Objectives: The aims of this cross sectional study of adolescents in Puerto Rico (PR) were to evaluate: (1) prevalence of malocclusion and (2) occlusal characteristics of 13-17 year old Puerto Rican adolescents from selected public schools in the municipality of San Juan during 2012-2013. Methods: A convenience sample of 135 adolescents aged 13 to 17 years from 3 public schools were recruited. University of Puerto Rico’s IRB approved the study and the consent and assent were completed for each participant. A calibrated dentist performed a single visit dental evaluation at each school. Occlusal characteristics were measured and recorded according to the criteria adopted in the US National Health and Nutrition Examination Survey (NHANES III) and included overjet , overbite, anterior and posterior crossbites, incisor irregularity, maxillary midline diastema and Angle classification. Data were entered in MSExcel and statistical analysis was performed using SPSS for descriptive statistics. Results: 100% of the subjects showed at least one occlusal trait. 12% of the participants had severe overbite of 6mm or more and average overbite was 3.4mm. Maxillary midline diastema of 2mm or greater was found in 8.5% of 13-17-

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year-olds. 39% and 37% of subjects had 6 mm or more of maxillary and mandibular incisor irregularity, respectively. Posterior crossbite affects 9.2% of subjects and an overjet of 6mm or more was found in 5% of subjects. Regarding Angle molar classification, 74% percent of subjects presented with Class I malocclusion, 6% presented Class II malocclusion, and 19% presented Class III malocclusion. Conclusion: The results showed a high prevalence of malocclusion, highlighting the need to implement preventive measures to improve the oral health of this population. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): PR Trust of Research and Technology, Colgate Palmolive Research Donation and Triple S A-168

Prevalence of Impacted Maxillary Canines of Puerto Rican Adolescents Giancarlo Tassara, Lydia López del Valle, Rosana Hanke, Francis Picón, Sona Tumayan. University of Puerto Rico Medical Sciences Campus Background & Objectives: The aims of this cross sectional study of adolescents in Puerto Rico (PR) were to: (1) Estimate the prevalence of impacted maxillary canines (2) Calculate the percentage of maxillary canines with delayed eruption (3) Determine the association between gender and maxillary impacted canine. Methods: A convenience sample of 135 adolescents aged 13 to 18 years from 3 public schools was recruited. University of Puerto Rico’s IRB approved the study and the consent and assent were completed for each participant. A single visit dental evaluation was performed at the school by a calibrated dentist. The dental evaluation consisted in determine presence or absence of maxillary canine into the maxillary arch and calculate the percentage of canines partially erupted. Periapical radiographs were taken to confirm presence of canine when impacted. When a bulge was present localization was registered as buccal or lingual if feasible. Participants received a behavioral risk questionnaire. Data were entered in MSExcel and statistical analysis was performed using SPSS for descriptive statistics. Results: For the Total sample: Mean age =16.5 years; a prevalence of 3.6 % of impacted canines and 2.2 % of delayed erupted canines , with a total of 5.9% patients that would need orthodontic treatment regarding the canine position. Males had the higher prevalence of impacted maxillary canines. Conclusion: The recent study provides results supported by previous studies of impaction and includes delayed eruption as a condition that combined, would need treatment eventually in 5.9% of the population. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): PR Trust of Research and Technology, Colgate Palmolive Research Donation and Triple S A-169

Obesity, High Blood Pressure and HbA1c in Puerto Rican Adolescents Sheira Ramos-Vélez, Lydia López del Valle, Rosana Hanke. University of Puerto Rico Medical Sciences Campus

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Background & Objectives: The aim of this cross sectional study was to evaluate the prevalence of high blood pressure, pre diabetes and obesity in a group of Puerto Rican (PR) adolescents. Methods: A convenience sample of 135 Puerto Rican (PR) adolescents ages 13 to 18 years from 3 PR public schools was recruited. The University of Puerto Rico’s IRB approved the study. One visit dental evaluation was performed at the schools by a calibrated dentist. Height, weight and waist circumference were measured. Blood pressure and HbA1c were measured. Statistical analysis was performed using SPSS. Results: Participants distribution were: obese(32%), overweight(16%), healthy weight(50%) and underweight(1.5%); females were 62%. Blood pressure greater than 130/100 was found for 13.6% of the total sample of adolescents: obese (38.5%), overweight (5.5%), healthy weight (3.4%) and underweight (0%). Five percent of the sample have HbA1c greater than 5.7 (range 5.76.5). Of this 5%, 4 were obese and 1 healthy weight. Of the 5% with high blood pressure, 2 subjects had HbA1c greater than 5.7 and were obese.Using t test and logistic regression analysis statistical significant differences were found for obesity and high blood pressure (p < 0.001). No significant differences were found for high levels of HbA1c and obesity (p = 0.59). Conclusion: The results of this study showed an important finding of high blood pressure measurements in obese adolescents. Metabolic syndrome may be a risk of future cardiovascular disease and diabetes in adolescence. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): PR Trust Of Research And Technology, Colgate Palmolive Research Donation and Triple S A-170

Caries experience of a group of GDM Puerto Rican Pregnant Women Lydia López del Valle, Carmen Buxo, Karen Novak, John Novak, Jeffrey Ebersole. University of Puerto Rico Medical Sciences Campus; University of Kentucky, United States of America Background & Objectives: No study has been performed on the caries experience on gestational diabetes mellitus pregnant women. The aim of this study was to determine the prevalence of dental caries and DMFT/DMFS indexes among PR gestational diabetes pregnant women. Methods: As a part of an on going clinical study, a cross-sectional data analysis was carried out for the caries prevalence and indexes of a sample of 69 PR gestational diabetes mellitus (GDM) pregnant women based on the baseline visit. At the baseline dental exam the following variables were recorded on each patient: age, weeks of pregnancy, the Decayed, Missing and Filled Teeth and Surfaces Indexes following ICDAS criteria, pocket depth and bleeding on probing, time of last dental visit and procedures performed at it and others. Statistical analysis was carried out with SPSS on an Excell data base. Descriptive statistics were reported. Results: The prevalence of dental caries for the GDM was 72.4%, 48.2%

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severe caries (DS5-6=3.3). Mean age of the sample was 29.33 years. Mean gestational weeks were 26.88. The D3-6T = 4.70 ± 5.36; FT= 6.96 ±4.97; MT=2.23±2.6, and D3-6MFT = 13.93 ± 7.31. The D3-6S = 7.22± 9.96; FS = 10.56± 8.5; D3-6MFS = 20.05 ± 11.87. Fifty five percent of the patients had more than 1 missing tooth (range 1=8) and 5% presented retained roots (range 1-6). Last time of dental visit ranged from 2 months to 10 years and the most prevalent procedure reported was dental cleaning (72%). Conclusion: High caries rate and dental disease was found in this group of pregnant women. Proper oral hygiene habits in GDM pregnant women should be encourage. Educational strategies on the importance of oral health during pregnancy should be implemented. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Supported by NCRR Administrative Supplement ARRA funds Parent Grant 5P20RR020145-05 A-171

Description of Inflammatory Bowel Disease in Pediatric Patients in Puerto Rico Michelle M. González, Lourdes García, Francisco E. García, Gabriel Hernández, Alexandra Montalvo, Migdalia Feliciano, Antonio Del Valle, Yasmin Pedrogo. University of Puerto Rico Medical Sciences Campus Background & Objectives: Recent evidence suggests that the natural history of pediatric inflammatory bowel disease (IBD), mainly Crohn’s disease (CD) and ulcerative colitis (UC), varies significantly from adult IBD and between racial minorities. Our objective was to describe a pediatric IBD population in Puerto Rico. Methods: A cross sectional approach was utilized. A total of 70 subjects with a confirmed diagnosis of IBD up to 21 years old were recruited from 9 outpatient gastroenterology clinics throughout the island. Data was obtained from medical records by trained study personnel. Gender-specific means and frequency distributions of demographic and clinical characteristics were calculated in a standard fashion. Results: Our population had a mean age of 15.3 years (+ 4 SD) and a mean age at diagnosis of 12.2 years (+ 4 SD). Most were male (57.1% IBD, 62% UC and 55% CD) and 73.1% had CD. Furthermore, 42.8% had public health insurance while 38.5% had private. The most common symptoms upon diagnosis in both UC and CD patients were bloody diarrhea, loose stools and abdominal pain. Disease location in patients with UC was mostly limited to the rectosigmoid colon. The most frequent endoscopic finding in UC patients was backwash ileitis. Conversely, the majority of CD patients had ileocononic disease and had patchy colitis on endoscopy. Conclusion: Although our data is currently not comparable to other studies, our preliminary results suggest that there are demographic and clinical differences in our pediatric IBD population. Prospective, multicenter studies are warranted to further characterize and compare our population with Caucasians and other racial minorities.

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Child, Adolescent, and Young Adult Suicide Trends in Puerto Rico: One Decade Patricia Vázquez-Toro, Adriana B. Rojas-Jiménez, Gloria González-Tejera, Carlos Morales-Rodríguez. University of Puerto Rico Medical Sciences Campus Background & Objectives: Suicide is a serious mental health problem whose prevalence has increased over the years in many countries including Puerto Rico. Given the scarce amount of descriptive statistics regarding completed suicide in Puerto Rico the purpose of our study was to describe the trends of children, adolescents, and young adults’ suicide between the years 2000 and 2010 in the island regarding age, sex, judicial region, suicide method, month, and season of year. Methods: This was a descriptive, retrospective study about suicide prevalence among children, adolescents, and young adults (20 years and under) in Puerto Rico. Investigators reviewed existing data regarding suicide statistics provided by Puerto Rico’s Forensic Science Institute. Data was gathered only for individuals under age 21 (n = 175). Various domains (age, sex, judicial region, suicide methods, month, and season of the year) were analyzed using descriptive statistics methods. Results: The preliminary findings show that suicide was more prevalent in the age group between 18 and 21 years of age, in males, during spring, and asphyxiation by suspension was the most common method employed. In the case of the 18 to 21 age group, Bayamon was the region with most completed suicides. However, Ponce was the region with the highest prevalence in those under age 18. Suicide was more prevalent in January for the age group younger than 18 years of age and March for those under 21. Conclusion: Thus, these preliminary findings point out that suicide, especially between these age groups is not something to be overlooked. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The authors thank Sonia I. Jimenez Mirles and Puerto Rico’s Forensic Science Institute for providing the database. There is no potential conflict of interest identified. A-173

Type 2 diabetes mellitus and colorectal neoplasia risk in Hispanics: A case-control study Cristina Cardona, Yaritza Díaz-Algorri, Dilka González, María E. Lozada, Sofía M. López, Jessica Hernández, Carmen Pedrosa, Doris H. Toro, Marcia R. Cruz-Correa. University of Puerto Rico Medical Sciences Campus; University of Puerto Rico Comprehensive Cancer Center; VA Caribbean Healthcare System Background & Objectives: Epidemiological studies have provided inconclusive evidence regarding the potential link between type 2 diabetes mellitus (DM) and colorectal cancer (CRC). The association between type 2 DM and colorectal cancer and/ or adenomas has not been well studied in Hispanics. The objective is to evaluate the association between type 2 DM and colorectal neoplasia (CRN) in Hispanic adults. Methods: The casecontrol study included patients with incident CRN and controls

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with negative colonoscopy and without previous history of CRC or adenomas diagnosed from January 1, 2005 to December 31, 2009. Diagnosis of type 2 DM was established by previous medical diagnosis and/or anti-diabetic medications use. Unconditional logistic regression was employed to estimate the odds ratio (OR) between type 2 DM and CRN using SPSS 17. Results: A total of 472 participants (mean age 60.3 ± 12.5 yrs., 58.5% males), prevalence of type 2 DM was 25.0%. 318 patients with CRN and 154 controls were evaluated. Cases and controls did not differ by median age (p=0.80), family history of CRC (p=0.65) and first degree of family history of DM (p=0.58). There was a statistical significant association between DM and CRN in women (OR=5.77; 95% CI: 1.26-26.42) on adjusted analysis. There was no a statistical significant association between DM and CRN in men (OR=1.17; 95% CI: 0.63-2.19) on adjusted analysis. Conclusion: A tendency towards an increased risk of colorectal neoplasia was observed among type 2 DM patients. We observe a statistically significant association between type 2 DM and CRN in women. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The project was supported by Award Number U54 RR026139 from the National Center for Research Resources, the Award Number 8U54MD 007587-03 from the National Institute on Minority Health, National Cancer Institute Award Number 5K22CA115913-03, R21CA167220-01 and U54CA096297. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. A-174

Health Determinants and Health Outcomes Disparities in Hispanics Older Adults Living in Puerto Rico Elsa M. Orellano, Mariel López-Valentín. University of Puerto Rico Medical Sciences Campus Background & Objectives: Ethnic minority populations of older adults in the U.S. experience health disparities compared to their white counterpart. This study estimated the prevalence of health outcomes and health determinants between Hispanic Older Adult (HOA) living in PR and HOA living in the U.S. Methods: We used data from the 2010 BRFSS (land line only). The analysis was limited to 6,699 Hispanics aged 65 y/o and older. Prevalence measures and cross-tabulations were completed to look at social determinants of health by ethnicity. Results: Older Hispanics living in PR showed a greater proportion of not graduating from high school (HOA PR: 49.5% vs. HOA US: 40.9%) and income less than $25,000 (90.9% vs. 51.2%). They also reported being less likely to engage in physical activity (52.0% vs. 36.3%) and more likely to never have had a digital rectal exam for prostate cancer (25.3% vs 21.7%). They showed greater proportion of self-rated poor health (59.4% vs 43.9%) and a higher proportion of ever diagnosed with angina or coronary heart disease (17.3% vs 11.3%). Conclusion: HOA living in PR have a much higher prevalence of socioeconomic factors, health-risk behaviors and medical conditions than are

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found in HOA living in the U.S. Improved health-care access, better preventive screenings, and targeted community-based health promotion programs and policies should be examined as possible ways to reduce health disparities. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): This research was supported by Grants 5S21MD000242 and 5S21MD000138, National Center for Minority Health and Health Disparities, National Institutes of Health. Endowed Health Services Research Center, School of Medicine. A-175

Nutrition and environmental factors that influence the food pattern of children with autism Alexandra Cruz, Ivonne Angleró. University of Puerto Rico Medical Sciences Campus Background & Objectives: To describe the nutritional profile of the population of children receiving services at an Autism Center of the Puerto Rico Metropolitan area. Methods: Data from 36 medical records of the Autism Center of UPR- Medical Science Campus were review. Anthropometric and demographic data, food selectivity, co-morbidities, supplements use, gastrointestinal problems, food allergies, diagnostic classification, behavior while feeding, lactation profile and other information that compose the nutritional profile were obtained. Mean, standard deviation and range was obtained for the anthropometric profile; while frequency described all other variables. Food selectivity and weight classification was compared to see if there was any correlation using Chi-Squared. Results: Food selectivity was present in 21 (58.3%) of participants. There was no statistical correlation between food selectivity and weight classification (chi-squared value of p=0.571 for children 2-5 years and value of p=0.248 when comparing for children 18 months23 months). There was no identifiable preference for any food group, nevertheless, a predominant reason for food selectivity was observed to be texture. Conclusion: Our study found no association between food selectivity and weight classification, but the presence of food selectivity is a risk for this population of nutritional deficiencies or excess that are not reflected on weight status. It is our recommendation that a Licensed Dietitian makes part of the professional team of an Autism Center for proper nutritional assessment, diagnostic and intervention. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): No funding sources were used for the purpose of this research. The authors have no conflict of interest to disclose. A-176

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Association between Perceived Accessibility to Alcohol and Binge Drinking among Adolescents in PR Linnette Rodríguez-Figueroa, Juan C. Reyes-Pulliza, Margarita R. Moscoso-Álvarez, Hesmy SánchezVega, Héctor M. Colón. University of Puerto Rico Medical Sciences Campus; University of Puerto Rico Rio Piedras Campus; Universidad Central del Caribe, Bayamón, Puerto Rico

Background & Objectives: Alcohol is the most commonly used substance among teens. Even more troubling, 1 out of every 5 US teens report binge drinking (≥5 drinks in a row) in the last month, a dangerous drinking pattern that increases their risk for several health problems and impairs their decision-making ability. The objective of this study was to estimate the prevalence of binge drinking among Puerto Rican adolescents and to evaluate the association between perceived accessibility to alcohol and binge drinking. Methods: This study is a secondary analysis of "Consulta Juvenil VIII", an island-wide crosssectional survey. The sample (n=10,134) was selected using a multi-stage stratified cluster sampling design, and is representative of all 7th-12th grade students in PR. Data was collected using a pre-coded self-administered questionnaire. Multiple logistic regression models were fitted. Results: Approximately 93,643 adolescents (34.4%) in PR have recently consumed alcohol (last month), most of whom (61.2%) indulged in binge drinking at least once during that period. Binge drinking was more frequently reported by males and high school students. Over half (61.1%) the students believe that it would be easy or very easy to get alcohol. Over 80% of those who reported binge drinking find it easy to get alcohol. Students who reported easy accessibility to alcohol had 35% higher odds of binge drinking than those who found it hard after adjusting for socio-demographic characteristics (gender, school level, parents' education, and school system). Conclusion: Interventions targeted to limiting the availability of alcohol should have a great impact on decreasing risky drinking behavior among teens. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Research supported by the Puerto Rico Mental Health Services and Drug Addiction Administration (ASSMCA, by its acronym in Spanish). A-177

Malnourished Hemodialysis Patients Profile Roberta M. Lugo-Robles, Damaris Vázquez, Himilce Vélez. Ponce School of Medicine and Health Sciences, Puerto Rico Background & Objectives: Over 40% of hemodialysis (HD) patients are malnourished due to protein-calorie malnutrition and it’s related with morbidity and mortality. Project objective was to develop a profile of malnourished hemodialysis patients to facilitate their identification and management. Methods: A total of 177 patients with serum albumin levels of ≤3.5 g/dl were recruited. Patients were eligible to participate in a six months oral nutritional intervention. Baseline data from the oral nutritional intervention were used to create the profile. Results: Results showed a total of 44.1% females in the sample, a mean age of 67.43 years, diabetes mellitus prevalence (83.1%), history of cardiovascular disease (60.5%), history of previous nutritional supplementation (54.2%) and average time on dialysis 27.33 months. Average baseline levels of the nutritional and clinical parameters were: nPCR (0.99g/kg/day), blood hemoglobin (10.75 g/dl), serum albumin (3.22g/dl) and TIBC (183.14µg/

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dl). Serum albumin levels confirmed a poor nutritional status among HD patients. Malnutrition Inflammation Score test showed 44% of the HD patients were severe malnourished. Conclusion: HD patient profile identified an elderly population with nutrition problems and identified several factors may be involved on the cause of malnutrition such as age, time in dialysis, diabetes and cardiovascular disease. Patient profile will help determine if oral nutritional supplementation is necessary for the hemodialysis patients. In conclusion achieving evidence‐based consensus can help in implementing the progress of knowledge in clinical practice and will help to identify major risk factors that lead to the elderly hemodialysis patients to suffer malnutrition. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Authors express sincere gratitude to the Dialysis Company and its president Dr. Otegbola Ojo, Damaris Vázquez, director of the Department of Nutrition and Dietetics of the company, Ylene Rodríguez company epidemiologist, dietitians, social workers and nurses for providing all the support and helpful comments and suggestions. A-178

Recommendations to Dental Professionals on a Social Level for Increasing OCS: A Qualitative Approach Daniel Díaz-Rubayo, Rafael A. Gavilanes-Méndez, Omar García, Augusto R. Elías-Boneta, Walter J. Psoter. University of Puerto Rico Medical Sciences Campus; Lutheran Medical Center, New York Background & Objectives: Puerto Rican men have one of the highest oral cancer (OC) rates in the Americas with evidence of a general delay in diagnosis. Increasing quality oral cancer screenings (OCS) in dental offices may partially address this delay. The aim of the study was to explore recommendations made from faculty at the University of Puerto Rico School Dental Medicine (UPR-SDM) and private practitioners residing in PR, on the social and organizational level to increase OCS. Methods: Two focus groups (FG) comprised of 7 academics; three with clinical practices and 9 private practice dentists, members of the PR Dental Society. These were overseen by two experienced qualitative researchers. Results: (1) The public needs to be empowered with knowledge of and expectations for OCS by dentists, (2) General Practitioners (GPs) should be able to bill for oral biopsies to all insurance companies, (3) in light of the mandated preventive services included in the Patient Protection and Affordable Care Act, the Puerto Rico College of Dental Surgeons (CCDPR) should promote discussions with health insurance companies regarding reimbursements for screening and adjunct diagnostic tests, (4) auxiliary dental staff could act as oral cancer screening resources. Conclusion: GPs in our FGs assure the quality and quantity of OCS in Puerto Rico can be increased through a change in oral health service system. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): University of Puerto Rico School of

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Dental Medicine (UPRSDM), New York University College of Dentistry (NYUCD), NIH Funds A-179

Prevalence of allergic diseases in children living in communities adjacent to the Caño Martín Peña Camille A. Moreno-Gorrín, Cynthia M. Pérez, Erick Suárez. University of Puerto Rico Medical Sciences Campus Background & Objectives: The prevalence of allergic diseases has increased worldwide, affecting the quality of life of children and posing a serious burden on families and society. However, few data are available on the current status of allergic disease prevalence in underserved children living in the communities adjacent to the Caño Martín Peña (CMP). This study described the prevalence of childhood allergic diseases in children aged 6-14 years living in the CMP. Methods: 147 consecutive children who received health services at a primary care center in Barrio Obrero were recruited between February and August 2013. Parents were interviewed to collect information on sociodemographic, residential and lifestyle characteristics. An adapted version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to determine the prevalence of asthma, allergic rhinitis, and eczema within the previous 12 months. Prevalence was estimated with 95% CI using the normal approach. Results: Mean age of participants was 9.6±2.4 years, and 52.4% were females. Prevalence of allergic diseases in the last 12 months, based on ISAAC, was 22.5% (95% CI: 15.9-30.0) for asthma and 44.2% (95% CI: 36.0-52.6) for eczema. Based on self-reported diagnosis, estimates were 48.9% (95% CI: 40.7-57.3) for asthma and 18.5% (95% CI: 12.5-25.7) for eczema. Prevalence of self-reported allergic rhinitis was 11.7% (95% CI: 6.98-18.1). Conclusion: Prevalence of self-reported asthma was higher than that based on ISAAC; however the opposite trend was observed for eczema. Further studies exploring the reasons of the observed differences are warranted. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): HealthproMed Clinic staff and Proyecto ENLACE del Caño Martín Peña. The study was approved by the UPR-MSC IRB (# 6050113) A-180

Association between Metformin® and breast cancer in 30-79 year old women from San Juan Puerto Rico Carola T. Sánchez, Cruz Nazario, Erick Suárez. University of Puerto Rico Medical Sciences Campus Background & Objectives: Breast cancer (BC) and diabetes are two of the most prevalent chronic diseases affecting Puerto Rican women. Recent studies have been indicating the possible relationship between the frequently used diabetic control drug Metformin® and BC risk modification. Our aim was to evaluate the relationship between BC and Metformin® among 30-79 years old women from San Juan, Puerto Rico. Methods: A case-

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control study was conducted for type 2 diabetic women identified from the base-study entitled Epidemiology of breast cancer in Puerto Rico (Atabey). A telephone interview was performed to assess use of Metformin®. BC risk factors were obtained from Atabey database. Logistic regression analysis was performed to determine factors associated with BC risk. Results: The use of hormone replacement therapy was different among cases (40.0%) and controls (9.1%), but the difference was marginally significant (p=0.07). Results from the unadjusted logistic regression analysis suggests a small increase in BC in diabetic women who didn’t use Metformin® (POR: 1.06, 95%CI: 0.185.97) when compared with diabetic controls that used Metformin®. When stratified by age we found a decreased risk, though not statistically significant, in women older than 64 years of age using Metformin® (OR: 0.83, 95%CI: 0.07-10.34). Conclusion: Our study suggests that Metformin® is protective for BC in women. The magnitude of the association and the lack of statistical significance may be explained by study limitation: small sample size. Future studies to further assess the association between Metformin® and BC are needed. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The content is solely the responsibility of the authors. A-181

Birth Prevalence of Oral Clefts in Puerto Rico (2001-2010) Mairim Soto-Ortiz, María A. Ángulo-Martínez, Nicole Esquilín, Nadya V. Sullivan-Viñas, Carmen J. Buxó-Martínez. University of Puerto Rico Medical Sciences Campus Background & Objectives: Orofacial clefts (CL/P) are one of the most common birth defects in Puerto Rico. These malformations are located in the facial area including the nose, lips and palate of the individual. The aim of this study is to evaluate the birth prevalence rates of orofacial clefts in Puerto Rico and describe its time trends and patterns. Methods: An analysis of the birth prevalence of CL/P in Puerto Rico was performed to describe its time trends and patterns based upon data from the Puerto Rico Birth Defects Surveillance and Prevention System. The prevalence of CL/P from 2001-2010 was presented for two time periods (2001-2005 and 2006-2010) and analyzed using Fisher’s Exact Test. Results: Overall prevalence for 2011 was 18.0/10,000 live births. Trend analysis showed a significant increase (ppT2) was calculated using GS and TS. Unadjusted and adjusted logistic regression models were used to define the association between demographic and clinical characteristics with PCa severity. Results: Overall, 50.6% of men were ≥ 60 years, 78.9% were overweight/obese, 36.7% have hypertriglyceridemia and 32.0% have hypoalphalipoproteinemia. In the unadjusted logistic regression analysis, hypertriglyceridemia (OR: 2.20, 95% CI=1.14-4.26) and hypoalphalipoproteinemia (OR: 2.11, 95% CI=1.08-4.12) was

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significantly associated with PCa severity. Meanwhile, obesity (OR: 2.75, 95% CI=1.00-7.54) was marginally associated with PCa severity. However, in the adjusted logistic regression analysis, age, obesity and hypertriglyceridemia was marginally associated with PCa severity (0.05>p1.7 Million small chemical compounds) against these pharmacophore models; (3)Docking of drugs selected by the models, against a well-defined protein target in NS3. Results: Top-hits were ranked by predicted “binding energies” (kcal/ mol), with a total of 418 compounds identified with values below -9.5 kcal/mol (predicted sub-micromolar affinities). Five of those compounds were randomly selected and tested for cell toxicity and antiviral activity. Four compounds were found to have significant viral replication inhibition, while three of those compounds demonstrated an average survival of over 85% at a concentration of 100µM. Conclusion: In conclusion, our initial In Silico campaign resulted in the identification of large number of potentially high affinity top-hits, while results from our limited bioassay is consistent with the possibility that a significant number of those top-hits are biologically active and with low toxicity. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): In Silico Drug Discovery Team, RISE Program and NIH Grant number: 2R25GM059429-05, University of Puerto Rico at Cayey A-257

Novel Adenosine/Uridine-Rich Element-Binding Proteins Recognize Interleukin-3 mRNA in T Cells Marina Martínez, José A. González, Marimar Hernández, Carlos González. University of Puerto Rico Medical Sciences Campus Background & Objectives: Human Interleukin-3 (hIL-3) is a cytokine that promotes myelopoiesis, differentiation of macrophages and granulocytes. Aberrant expression of this lymphokine has been associated with several hematological cancers. IL-3 3’-UTR harbors Adenosine/Uridine-Rich Elements (AREs) involved in its post-transcriptional control. These regulatory sequences are recognized by specific AREBinding Protein (ARE-BP) complexes. Previous results from

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our laboratory estimated five ARE-BP complexes from 34 to 88 kDa binding to the hIL-3 ARE using UV-crosslinking assay. Our goal is to identify novel ARE-BPs that mediate the posttranscriptional regulation of hIL-3. Methods: To achieve this goal, RNA affinity purification coupled with MS/MS analysis was performed. Also, an immunoblot analysis to confirm the presence of specific proteins was carried out. Results: These results identified ~40 proteins between 12 to 82kD interacting with the hIL-3 ARE in acute lymphoblastic leukemia cells. MS/MS results in accordance with previous results from our laboratory showed that HuR and p32hnRNP C1/C2 are components of the ARE-BPs that recognize the hIL-3 ARE. In addition, our results identified KSRP and SAM68 as novel hIL-3 ARE-BPs. Besides, we found that p45AUF-1 protein interacts with hIL-3 ARE. Conclusion: Taken together, these data imply that novel ARE-BP complexes can play an important role in the IL-3 post-transcriptional regulation. Ultimately, elucidating the role of these ARE-BPs in IL-3 expression can provide new insights about the ARE-mediated post-transcriptional regulatory pathway and blood cancer. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): This research was supported by MBRS-RISE Program R25GM061838 and UPR-PES Intitutional funding. A-258

Novel CBZ-Intercalated ZrP Nanomaterials Natcha Vicente-López, Barbara Casañas, José L. Agosto, Jorge L. Colón. University of Puerto Rico Rio Piedras Campus Background & Objectives: We are interested is the intercalation of different drugs in layered inorganic materials in hopes of developing new and more efficient drug delivery treatments. Zirconium phosphate (ZrP) is a layered inorganic material whose well-studied alpha (α-ZrP) phase has an interlayer distance of 7.6 Å, while its less-studied tetha phase (θ-ZrP) has an interlayer distance of 10.3 Å. We are using θ-ZrP in the intercalation of different compounds. The drug being used in our present studies is carbamazepine (CBZ) which is used primarily to treat epilepsy and bipolar disorders. CBZ has poor solubility in water, making the process of intake in the body more difficult. Methods: The intercalation reaction between CBZ and ZrP was performed using a 200 mL 1:1 water and ethanol solution with the compounds in a 5:1 molar ratio. Results: To analyze the product of the intercalation reaction we used X-ray powder diffraction (XRPD); if the interlayer distance between the layers of the product material is more than 7.6 Å, it indicates that the intercalation reaction was successful. The XRPD pattern shows that the product has an interlayer distance of 10.3 Å, indicating that we were able to produce a new CBZ-intercalated ZrP phase with an expanded interlayer distance. We also used infrared spectroscopy to characterize the CBZ-intercalated ZrP material and observed vibrational peaks characteristic of CBZ. Characteristic signals of CBZ were also observed in the diffuse reflectance spectrum and SEM-EDS of the intercalated pro-

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duct. Conclusion: Our results indicate that we were successful in intercalating CBZ into ZrP. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.) Funding Sources: RISE and PR-LSAMP Program. A-259

Characterization of Androgen Receptor in Epithelial Ovarian Cancer Carolina Montañez-Miranda, Lisa K. Mullany, JoAnne S. Richards. University of Puerto Rico Cayey Campus; Baylor College of Medicine, Texas, United States of America Background & Objectives: Ovarian cancer (OC) is one of the most lethal malignancies among women. Using Pten fl/fl;LSLKrasG12D;Amhr2-Cre (P53+) and Pten fl/fl;P53 fl/fl;LSLKrasG12D;Amhr2-Cre (P53-) transgenic mouse models we measured the expression of Androgen Receptor (AR) in ovarian tumors and tumor microenvironment. The role of AR in the ovary is not fully understood, but it plays an essential role in follicular development. Since high levels of androgens are correlated with increased risk of OC and the incidence is higher after menopause, when androgens are the main steroids produced by ovary, we want to determine the impact androgens have on OC cell growth. Methods: Ovarian serous epithelial (OSE) cancer cells were isolated from P53+ and P53- ovarian tumors and injected intraperitoneal into the mice. Then, RT-PCR was performed on lysates from P53+ and P53- cells treated with DHT in culture. The omentum was sectioned, H&E staining was performed, and Immunofluorescence was done to measure the AR expression. Results: The omentum from mice injected with P53+ cells was larger than the P53-, and the expression was also at higher levels in P53+ OSE tumor cells. Also AR mRNA expression levels suggest that AR is expressed not only in ovarian cancer cells, but also in the tumor microenvironment. The DHT treated mice show proliferation of meso-epithelial cells in wt mice, and also confirm that metastatic P53+ cells express AR. Conclusion: These results suggest that androgens may play an important role in the development and or progression of OC depending on P53 status and may be a potential future therapeutic target. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): The Endocrine Society’s Minority Access Program supported this research. A-260

Fasciola hepatica fatty acid binding protein inhibits TLR-4 pathway activation Ivelisse Martin, Olgary Figueroa, Kimberly CabánHernández, Ana M. Espino. University of Puerto Rico Medical Sciences Campus Background & Objectives: Lipopolysaccharide (LPS) is a major component of the outer membrane of Gram-negative bacteria and a potent activator of the human innate immune system. The immune response to LPS can lead to septic shock syndrome if the inflammatory response is amplified and uncontrolled which can be fatal. Several proteins are important for LPS re-

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cognition and pathway activation including lipid binding protein (LBP), CD14, MD12 and Toll-like Receptor 4 (TLR-4). Today, there is a need to develop TLR antagonists that could prevent or circumvent the negative and sometimes fatal effect of inflammatory responses during a variety of human diseases. Methods: Here, we demonstrated that the Fasciola hepatica fatty acid binding protein (FhFABP) has antagonist properties through TLR-4 after LPS stimulation. Results: Using a proximity ligation assay (PLA) we showed that FhFABP interact with human CD14 co-receptor of HEK 293 cells to block the activation of NF-kB induced by LPS, functioning as antagonist of TLR4. Furthermore, real-time PCR (qRT-PCR) demonstrated that FhFABP inhibited the production of inflammatory cytokines as TNF-α, IL-1β, IL-12A and nitric oxide production by human monocyte-derived macrophage (MDM) in vitro. Conclusion: These findings of TLR4 pathway inhibition open doors to further studies directed to explore the potential of FhFABP as a new class of drug against endotoxemia / septic shock bacterial or others inflammatory diseases in which TLR4 are involved. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): This study was supported by MBRS-RISE R25GM061838-13, NIH-SCORE1SC1AI096108-01A2 and NCRR 2612-RR003051/8G12MD007600. A-261

Isolation and Characterization of Simalikalactone D from the Puerto Rican Plant Simarouba tulae José R. Molina, Elsa M. Luciano, Claudia A. Ospina. University of Puerto Rico Cayey Campus Background & Objectives: The family of the Simaroubaceae has been reported to have a variety of biological activities, including anti-malarial, anti-inflammatory, and anti-cancer properties. The main secondary metabolites isolated from this family of plants are compounds with general structure of quassinoids, a group of highly oxygenated terpenes found only in simaroubaceous genera and are considered taxonomic markers of this plant family. The specie Simarouba tulae is an endemic tree in Puerto Rico that has not been investigated for its potential biologically active constituents. In this study, our objective is to analyze through a bio-guided isolation protocol the main secondary metabolites responsible for the anticancer activity of this plant extracts from pure compounds of the Simarouba tulae. Methods: The leaves from the plant were extracted with a mixture of CH2Cl2-MeOH (1:1). The resulting crude extract was suspended in water and extracted with organic solvents and dried by distillation. Results: The resulting extracts were tested for their growth inhibitory activity against MCF-7 and T47D breast cancer cells via a MTT-based protocol assay. Among the extracts examined, the chloroform extract showed anticancer activity at 100 μM with growth inhibition of >80% against both MCF-7 and T47D cell lines. On the basis of the initial activity we performed, the bio-guided fractionation of the chloroform extract resulted in the isolation of the pure quassinoid derivative simalikalactone D. Conclusion: We conclude that

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this plant specie is an important natural source that can provide new therapeutic leads for the discovery and development of new anticancer drugs. Acknowledgements (Funding Sources, Conflict of Interests Disclosures, etc.): Supported by the Institute of Interdisciplinary Research Grant NIH/NIMHD (#1P20MD006144-01) and DAA at UPR Cayey. A-262

Detection of hydrogen peroxide-induced mitochondrial DNA damage in H9c2 cardiomyocytes Adlín R. Rodríguez-Muñoz, Giselle A. Barreto-Torres, Jessica M. Soto-Hernández, Sylvette Ayala-Peña, Sabzali Javadov, Carlos A. Torres-Ramos. University of Puerto Rico Medical Sciences Campus Background & Objectives: Oxidative stress plays a crucial role in the pathogenesis of cardiovascular diseases such as myocardial infarction (ischemia), hypertrophy and heart failure. Reactive oxygen species can induce a variety of DNA lesions in nucleus and mitochondria. However, quantitative analysis of DNA lesions in various tissues and cells, including cardiac cells, requires individual methodical approaches. In this study, we aimed to apply the Quantitative Polymerase Chain Reaction (QPCR) assay for quantification of mitochondrial DNA (mtDNA) lesions in cardiomyocytes subjected to oxidative stress. In this assay, lesions that blocks the progression of the thermostable DNA polymerase result in decreased amplification of the PCR product, giving a relative measure of the lesions present in the target sequence. Methods: H9c2 embryonic rat cardiomyocytes cultures were treated for 1 h with increasing concentrations of H2O2 (25, 50, 75, 100, 200 µM) followed by DNA isolation and QPCR analysis. Results: Cells treated with 75, 100, 200 µM of H2O2 showed a significant reduction in the relative mtDNA amplification which were 60%, 20% and 10% (p